I was told by my plastic surgeon, that Juvederm would not "effectively address" the horizontal wrinkles that run across my forehead. These lines are not deep, but they are very noticeable. If a combination of Botox and Juvederm won't work to reduce these wrinkles, then is there an injectible treatment for them? What are my other options?
Treatment for Horizontal Forehead Wrinkles?
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Doctor Answers 18
Horizontal Forehead Wrinkles
I don't agree with your doctor unless you have absolutely no response to Botox. Most of my patients have a combination of Static and Dynamic Forehead wrinkles. I always start with 30 to 40 units Botox in the Forehead, but I have no problems using hyaluronic acid fillers which can help soften these lines.
I would avoid a surgical browlift (endoscopic or open). I think in most cases you can get just as good or better results in the forehead with botox and fillers.
Your plastic surgeon hit the nail on the forehead
Trust in your board certified plastic surgeon. He/she knows best, having examined you and assessed your individual needs. Go for the Botox. That is where your money is for softening the forehead lines. If it doesn't provide enough flattening or not a quick enough effect for you, then you can add fillers for deeper lines. The combination of the two will also allow for a longer effect of the filler. And it will stop your sweating. Good luck!
Injectables vs. surgery
Assuming you do not have significant brow and lid ptosis then Botox would probably be the first thing to try. Be advised that if you do have a lot of sagging tissue over your brow and lids that your frontalis muscle (the muscle over your forehead) is likely helping to keep skin out of your visual fields. Botox can make this worse.
Patients with these issues may need a brow lift or an upper lid blepharoplasty.
I hope this helps.
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Botox then fillers
As you can see, Botox is the primary treatment for forehead lines because it paralyzes the muscles that cause the wrinkles. IF you have practiced these wrinkles long enough, they becaome permanent and might also need some fillers to improve them. Chemical peels and laser resurfacing and browlifts can also be necessary in extreme cases to improve the region.
You may need a brow lift
If you have horizontal wrinkles which are only present with animation of your brows, then Botox will take care of them. If the wrinkles are there at rest, then you may need a combination of filler and Botox. However, if you have significant wrinkles at rest, the you may actually benefit from a brow lift which will stretch out the skin on your forehead. It really depends on the severity of your wrinkles and how much correction you are looking to achieve.
David Shafer, MD
A Little of This, (?) a Pinch of That: Paralyze, Then Patch
Wrinkle lines on the face or forehead which are the result of muscular activity typically cannot be effectively addressed by Hyaluronic Acid (HA) fillers. These "dynamic" lines will still be noticeable even after filling with HA, since the underlying cause has not been addressed. HA fillers do their best work in correcting volume loss and "static" lines and wrinkles that are less-directly-related to muscle activity, such as the nasolabial folds and marionette lines.
Most patients with horizontal forehead wrinkles, and vertical lines and wrinkles between the brows, are treated effectively with Botox alone.
Occasional patients (including this author) who have very deep and long-standing horizontal forehead wrinkle lines, will require combination therapy to address the problem as completely as possible. Botox should be done first and allowed to reach it's full effectiveness. Any residual un-desired wrinkle lines can then be addressed with HA fillers. This synergy between the Botox and fillers is more effective in such cases than Botox alone.
Botox will help-But there is a price
As the several other doctors have mentioned, the lines of the forehead are due to the action of the muscles that lift the brows. The lines that come and go with expression (dynamic wrinkles) can be treated with Botox. The lines that are still present when you relax your brows (static wrinkles) will, initially, not be improved with Botox. Over time (many treatments) the skin will continue to regenerate and the static lines will improve.
An important issue is that the muscles that cause these wrinkles also lift the eyebrows. If they are treated completely, your brows may sit lower on your face. If you have very full or droopy upper eyelids the lower brows will make your eyelids look worse. You may not like this result. A skilled physician can balance the treatment so that you do not get a droopy eyebrow. However there may be a compromise and the wrinkles may be only partially treated.
I would try Botox for about a year before I would consider adding a filler like Juvederm. Unless you have very deep lines when your face is relaxed, in which case you could try Botox and a light treatment with Juvederm.
Botox is the best choice to reduce forehead lines.
Horizontal lines across the forehead are caused by muscle contractions under the skin. Botox temproarily paralyzes these muscles and therefore reduces the lines in the overlying skin. Fillers such as Restylene and Juvederm are used to fill in deep lines or grooves. Fillers work best for static lines such as marionette lines ( those lines going downward from the corner of the mouth) or nasolabial lines ( sometimes called smile lines). I have found that overtime with continued use of Botox forehead lines will continue to improve and become less noticeable. I would recommend continuing with the Botox and not using a filler.
Horizontal Forehead Lines and Botox... Does She or Doesn't She, Only Her Injector Knows for Sure
Not Luke Again,
Botox to your forehead will greatly improve if not obliterate any and all horizontal lines.
The price one pays for this is that the muscles that originally caused those horizontal forehead lines are unable to lift the brows, so that you will not get that nice Botox lift of your eyebrows. Nicole Kidman and Marcia Cross don't seem to mind.
There is a happy medium where a skilled injector with thorough knowledge of the facial muscle anatomy can reduce your "not so deep" horizontal forehead lines while still maintaining some function so that your eyebrows are elevated.
I agree that it is not a good idea to inject horizontal forehead lines with fillers unless you are partial to that Ruffle potato chip look on your forehead. Good luck and be well.
Botox along with a filler usually helps.
If the lines are not deep, Botox injections alone often work (20-25 units). If the lines are still bothersome after Botox (you have to wait 2 weeks to see), then adding a filler does the trick, but I would use a more forgiving filler for superficial lines.
I would use Restylane or even Cosmoplast here, even though I really like Juvederm for deeper lines and hollows. Restylane won't last as long, but you are less likely to get bumps.
For some patients, a subcutaneous forehead lift can be effective.