Diagonal lines on both sides of forehead, are muscles compensating? (Photos)

Question

I've had botox against frowning for 2 decades. Last year I started to see blue veins near my temples and I developed bunny lines. My doctor now injects very moderately. Just inside corners of eyebrows and high under my hairline. Eyebrows look even. Veins have been treated with laser and diminished. But now there are diagonal folds on both sides. I can smooth them out by pulling skin near corners of eyes lightly down. Are muscles compensating, pulling upward too hard? Doctor says its volumeloss

Eric M. Joseph, MD · Answer

I say this because the sulcus between your upper eyelid and eyebrows are deep. Based on your photos, it is not clear what those linear lines are. I have seen issues like this after thread lifting. The best advice would be to visit another reputable facial plastic surgeon for a second opinion. I hope this is helpful. Sincerely, Dr Joseph

Ella Fedonenko, MD · Answer

This is definitely a volume loss. I recommend a filler(Voluma) in the temple area to improve the appearance of these lines.

Anna Chacon, MD, FAAD · Answer

The appearance of diagonal lines on the forehead can be influenced by several factors, including muscle activity and volume loss. Here are some insights into your situation:

Muscle Compensation: Over time, with regular Botox use, the muscles that are not treated can become more active to compensate for the reduced movement in treated areas. This can sometimes lead to new lines forming in different patterns, such as the diagonal folds you are noticing. The muscles around the eyes and forehead, like the orbicularis oculi and frontalis, may adjust their activity in response to Botox injections, potentially contributing to these lines.

Volume Loss: As we age, the natural volume in our skin decreases due to the loss of collagen, fat, and other supportive structures. This can lead to skin sagging and the development of new lines or folds. Your doctor’s suggestion that volume loss is contributing to these diagonal lines is a common observation, especially if the skin can be smoothed out by adjusting its position manually.

Potential Solutions:
Dermal Fillers: To address volume loss, dermal fillers can be used to restore volume and smooth out lines. Fillers can be strategically placed to support the skin and reduce the appearance of folds.
Continued Botox Adjustments: Your doctor might continue to adjust the Botox technique to ensure balanced muscle activity, which can help prevent compensatory movements that might contribute to new lines.
Skin Tightening Treatments: Non-invasive treatments like laser therapy or radiofrequency can also help tighten the skin and reduce the appearance of folds.
Consultation with Your Doctor: It’s important to have a detailed conversation with your doctor about your concerns. They can assess your facial anatomy and muscle activity to create a personalized treatment plan that addresses both muscle compensation and volume loss.

Ultimately, a combination of treatments tailored to your specific needs may be the most effective approach to achieving a smooth and balanced appearance.

Camille Cash, MD · Answer

If you are seeing the lines that concern you when the Botox is in full effect, but less so when it wears off it could be that your muscles are compensating.  If they are there regardless of the Botox then it could be age related or volume loss.

Diagonal lines on both sides of forehead, are muscles compensating? (Photos)

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