21 - What can I do about these forehead creases and eyebrow asymmetry? (Photo)

Question

The forehead crease formed after years of raising my eyebrows to hide the crease between my eyes/ at the top of my nose. Also my eyebrows are uneven, I’m 21

Behnoush Zarrini, MD · Answer

At 21, the deep horizontal line you see is a result of muscle memory. Because you have been subconsciously lifting your brows to compensate for the bridge of nose crease, your frontalis muscle has become hyper conditioned, causing the skin to fold prematurely. Here is my professional assessment:
 + Corrective Neuromodulators: Using Botox or Daxxify is the most effective way to retrain the muscle to stay relaxed, allowing the etched skin to smooth out over time.
 + Symmetry Adjustment: We can address your eyebrow asymmetry by varying the dosage on each side, precisely balancing the resting height of your brows for a more symmetrical appearance.
 + Procerus Targeting: To stop the root cause of your brow lifting, we would also treat the crease at the top of your nose. This allows you to feel comfortable keeping your brows at a neutral, relaxed position.
 + Daxxify Advantage: Studies have shown that Daxxify can provide a very clean and long lasting smoothing effect for deeper lines, making it an excellent option for a strong frontalis muscle like yours.
When you completely relax your face in the mirror, does that deep horizontal line stay visible, or does it disappear when you stop lifting your brows?

Anna Chacon, MD, FAAD · Answer

At 21, what you're describing is actually quite common. Many people develop forehead lines not because of aging, but because of repeated facial expressions over time. If you've spent years raising your eyebrows to compensate for a crease between your eyebrows (the "glabellar" area), it's very possible that the forehead muscles have become overactive, leading to the horizontal lines you're noticing now.

The eyebrow asymmetry may be related as well. Very few people have perfectly symmetrical eyebrows. In some cases, one eyebrow sits slightly higher because the muscles on that side are naturally stronger or more active. Sometimes people unconsciously raise one brow more than the other when expressing themselves, which can gradually make the asymmetry more noticeable.

The encouraging news is that at your age, the skin generally still has excellent elasticity and collagen production. If the forehead creases are primarily expression-related rather than deeply etched at rest, they may be more responsive to treatment than similar lines seen later in life.

In general, treatment approaches focus on reducing the repetitive muscle movement that creates the creases and improving overall skin quality. Consistent sun protection is also important, since UV exposure accelerates the breakdown of collagen and can make expression lines become more permanent over time.

One thing I would keep in mind is that the forehead, glabella, and eyebrows all work together as a unit. Treating only one area without considering the others can sometimes make eyebrow asymmetry more noticeable. A thoughtful, balanced approach tends to produce the most natural-looking result.

Based on your description, the forehead lines and uneven brows sound more related to muscle activity and facial habits than to true aging, and at 21 there are typically several effective options for improving both concerns while maintaining a natural appearance.

Carl Truesdale, MD · Answer

At 21, persistent forehead creases come from one of three sources, and the right approach differs for each.
Frontalis overactivity (most common at your age):The frontalis is the muscle that raises your eyebrows. When it works harder than necessary (often unconsciously to compensate for tired eyes, dry contact lenses, or just habit), it creates horizontal forehead lines. Botox or Dysport in small doses softens the muscle activity and lines.
What's notable in your case: the asymmetry you mention is often a clue that one side of the frontalis is working harder than the other. Targeted Botox dosing &mdash; a slightly different amount on each side &mdash; can balance the asymmetry while softening lines on both sides.
Compensatory raising for brow ptosis:If your brow position is slightly low (even subtly), your frontalis works overtime to lift the brow throughout the day, creating lines as a side effect. In this case, Botox alone can make the issue worse (brow drops further when frontalis is relaxed). Solution involves addressing the underlying brow position &mdash; usually with a small temporal brow lift, even at a young age.
Genetic deep lines:Some patients have deeper dermal creases even without significant muscle activity. These respond to microneedling, fractional laser, or carefully placed superficial filler.
For the asymmetry specifically:Eyebrow asymmetry at 21 is usually one of two things:
Compensatory frontalis activity on one side (Botox fix as above).
Underlying skeletal asymmetry of the brow ridge (less common, no easy fix beyond camouflage with makeup or hairline work).
What I'd recommend at 21:Start with a careful Botox evaluation by an injector who specifically watches muscle behavior at rest and animation. The injector should observe you naturally for a minute or two &mdash; not just look at static photos &mdash; to understand which muscles are dominant.
Micro-dose Botox (sometimes called baby Botox) is often the right starting dose at your age &mdash; minimal units to soften activity without freezing expression. Three months later, reassess and adjust.
Avoid heavy doses at first, and avoid procedures targeting the brow ridge until you've seen what Botox alone accomplishes.

David Yew, MD · Answer

Botox is the most common treatment because it relaxes the forehead muscles that create the lines. Deeper static creases sometimes respond better to a combination of Botox plus SkinPen microneedling.  Asymmetry is normal, please watch our video that we have linked to how we apply it to aesthetics.

Danielle Shanley, MD · Answer

Hi! Great question! My first suggestion would be Botox or Dysport. If you've never heard about these injections, Botox and Dysport are neuromodulators that paralyze the muscle in the area of injection to decrease the depth of the current fine lines and wrinkles and prevent them from getting worse. Another treatment suggestion I have would be Morpheus8. Morpheus8 is radiofrequency microneedling that will help with the reduction of those deep fine lines and wrinkles while creating collagen stimulation and cell turnover. The best treatment plan would be to do both Botox and Morpheus8, and being 21 is the best time to start! This will prevent any fine lines and wrinkles from getting deeper!

Kally Papantoniou, MD, FAAD · Answer

In cases like this, a small amount of neurotoxin can help relax the overactive muscles and rebalance how the forehead and brows move together. The key is being conservative and strategic so you soften the lines without flattening the brows further or creating new asymmetry.

An experienced injector can tailor placement to subtly even things out rather than just “freeze” the area. It’s definitely something that benefits from an in-person evaluation so they can watch how your muscles move and adjust accordingly.

Stefan Weiss, MD · Answer

Botox can effectively soften forehead wrinkles by relaxing the underlying muscles, helping create a smoother, more youthful-looking appearance.

Camille Cash, MD · Answer

This crease may be softened by Botox.  It can help address brow asymmetry as well.  The treatment is done in the office with final results seen after two weeks.  To further treat the crease you can consider treatments such as SkinPen.  Visit with an expert injector to learn more.

21 - What can I do about these forehead creases and eyebrow asymmetry? (Photo)

Answers (8)

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