Botox in forehead - How do some women (like all the stars) avoid droopy brows, odd look and frozen forehead?

Question

I had Botox 10 years ago in my forehead and hated it. My arched brows fell and I looked like the worst "after" picture you can imagine. Now I have settled with just some between my brows and get a bit of forehead relief in the process. I have recently noticed that "doctors to the stars" seem to have figured out just the right method to give their patients a bit a movement, arched brows and no forehead lines. How? Is part of the effect how they apply brow make up too? I would love some advice.

Jerome Edelstein, MD · Answer

Botox injections are part art and part science. Your face is full of small muscles that pull in various directions in order to show emotion or to help you chew and protect your eyes. Where the injector chooses to inject, and how much Botox is used, contributes to the end result. You can get a frozen look if that's what you want. Or you can get a more natural appearance. The final result really all comes down to the skill of your injector.

Francis X. Fleming, MD · Answer

I don't want to look frozen!We've all seen the people with overdone Botox. They look expressionless and strange. Their faces may be frozen, their eyebrows may take on an unnatural arch. It's proof that you can have too much of a good thing. With my patients the goal if for them to look relaxed and rested. The goal is to have no wrinkles, but not at the expense of having no movement. I believe in a less is more approach. When patients come to me for the first time seeking Botox, I like to err on the conservative side. Once the full effect of the Botox has taken effect, if patients want to come in and have a little bit more injected then we can do that. I think this is preferable to injecting too much and having them have to wait 4-5 months for it to wear off.

Your face will most definitely have a lack of movement in the areas treated. The goal is to relax the muscles not paralyze them. When done correctly it will reduce the appearance of wrinkles while maintaining some movement and expression. I seek the maximum wrinkle minimization while maintaining some facial expression.How can I find an experienced injector?

When considering Botox, I can't stress enough the importance of seeking out an injector with skill and experience. I recommend limiting the search to board certified Plastic Surgeons and Dermatologists. Be wary of anyone who gives injections 'on the side'. You want an injector who has studied facial anatomy and will customize your injections to your face. An inexperienced injector may inject too much, or they may inject into the wrong muscles. Just a millimeter off can make a world of a difference. Some of these complications from Botox being administered incorrectly by untrained injectors can be very serious, even life threatening. Do you really want to put your safety into the hands of someone who has learned to do Botox during a weekend class? Just because the procedure is less invasive than surgery it does not mean it should be rushed into without proper research and thought.

Jimmy S. Firouz, MD, FACS · Answer

Although Botox is the most popular non-surgical cosmetic procedure, it doesn't mean that you should trust anyone to do your Botox injections. As you experienced first hand, if your Botox is not properly injected, you can experience an unwanted "frozen face." Botox injections work by blocking the impulses from the nerve to the facial muscles, thereby relaxing them. The result is the underlying facial muscles relax and the skin begins to smooth out. Your physician should ask you to scrunch your forehead, scowl, etc so he can see exactly how your facial muscles move and how strong they are. This helps him determine where to place the Botox and how many units are needed, to provide you with the naturally smooth results you are seeking.

M. Zakir Sabry, MD · Answer

Same muscle that lifts your brows i.e. frontalis,  also causes the wrinkles. It's a matter of balancing your animation. If one wants a frozen forehead, brows may drop. It is wise to selectively target the wrinkles, preserve some animation, thereby avoiding an un-natural look. Arch can be preserved and tail ends may also be lifted with precise injections.Celebrities - it's a whole another ball game. Most magazine photos may be photoshopped. Make up artists spend innumerable hours trying to hide flaws.

J. Jason Wendel, MD, FACS · Answer

Thank you for your question about Botox.It is important that you go to an expert injector for Botox.By the way, celebrities have the advantage of daily make up artists and photos that are air brushed and photoshopped.To be sure, see two or more licensed and board-certified providers in your area for a complete evaluation to make sure you are a good candidate and that it is safe for you to have these treatments.I hope this helps.

Gary Lawton, MD, FACS · Answer

It is all about the skill of the injector.  You need to find a plastic surgeon with skill that can do your injections.

Juan Carlos Fuentes, MD · Answer

There are different muscles in the forehead area, some pull down the brows, and the only one that can lift the brows is the frontalis muscle. The interaction of all these muscles, are different from patient to patient, as the shape, thickness, position and strength of each one can have a different effect on the brow position. The doctor who does apply the Botox, knows the anatomy, and should know about the patient's goal in regard shape and position of the brow. Then the doctor will know how many units the patient needs, where the Botox should be injected in order to get a natural look, and this is very different from patient to patient. What it works for one patient, may have a different effect in another patient.

Julia Ann Sullivan Miller, MD · Answer

Doctors all have their own techniques and methods when doing plastic surgery procedures.  Nonetheless, if you go to an experienced and well trained doctor, you should be able to explain your expectations.  Well qualified plastic surgeons understand the anatomy of the face, the mechanism of action of Botox, and should be able to achieve the look you want.  Good luck!

Louis C. Cutolo, Jr., MD, FACS · Answer

Thanks for your interesting question. The "doctors
to the stars" haven't figured out the "right" method. Because BOTOX
will paralyze your forehead, there may be some lowering of the forehead because
of the loss of muscle tone. If your arm becomes paralyzed it will hang, not
rise. That being said, there are techniques to minimize drooping and to attempt
to elevate the brows. If you want a completely frozen forehead, then the amount
you may need might lead to drooping of the brows. You can use just enough to
reduce the wrinkling but not completely freeze the forehead, and this will probably
not give you lower brows or forehead. You should discuss your goals with your
plastic surgeon but realize the more units of BOTOX that are used, the higher
the chance of getting a droopy brow.

Samuel Baharestani, MD, FACS · Answer

Remember that some of these tv and movie stars are also having cosmetic surgery to lift their brows and straighten their foreheads.  Sometimes, the biggest reason why someone has forehead lines is because they are compensating for a droopy eyelid by using the brow and forehead muscles to see better.  An ophthalmic plastic surgeon can help you to decide if surgery is a better option than botox for you.  Good luck!

Botox in forehead - How do some women (like all the stars) avoid droopy brows, odd look and frozen forehead?

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