Forehead tension causing deep mid forehead line. (Photo)

For 5 years or so now I have had chronic tension in my forehead. This has created a very distinct forehead line and as much as I try to relax my forehead muscle which feels like deeper muslces I cant. I have suffered with anxiety and an eating disorder so im not sure if it has to do with this. I did try botox with a neurologist but it didnt seem to do much except relax the surface muslces a bit. I am only 32 and it makes me so self conscious I hate it. Any advice much aprecated! Mia

Doctor Answers 13

Botox treatment for forehead frown lines

Thank your for your question. In treating deep frown lines, a combination of both anti-wrinkle injections such as Botox or Dysport and a medium to thick based Hyaluronic acid based dermal filler is initially advisable. Care must be taken when injecting any kind of filler in this area owing to the close anatomical proximity to 2 major arteries supplying the eyes, namingly the Supratrochlear and Supraorbital arteries. (Please see below diagram): 

Injecting filler into either or both of these arteries may lead to temporary or even permanent visual disturbance and even blindness, so please ensure that your injecting practitioner is both experienced and anatomically knowledgable in treating this area. Follow up treatments should only require anti-wrinkle injections alone provided that the initial treatment using both dermal filler and anti-wrinkle injections is successful.

Sydney Physician
4.7 out of 5 stars 14 reviews

Forehead tension causing deep mid forehead line

A combination of Botox Cosmetic® and a thinner-viscosity filler such as Belotero® or Restylane® can be a great option as a more complete treatment than Botox Cosmetic® alone for deep forehead wrinkles.

Manjula Jegasothy, MD
Miami Dermatologist
5.0 out of 5 stars 9 reviews

Botox for wrinkles

Thank you for your question miaalanna. I am sorry to hear about your situation. Botox is a purified protein used to address wrinkles associated with facial expression. When muscles in the face are used a lot wrinkles can be seen. This is the same as the definition one sees in the muscles on the body when exercising them. Botox relaxes the muscles so that they do not contract. If one has definition in a muscle on the body from exercising and then stops exercising the definition will go away slowly over time. Same with the face. The muscle needs to be relaxed with Botox on the face. But since most people enjoy the results of their Botox treatment for 3-4 months a maintenance treatment is recommended at that time to keep the muscle relaxed. After several sessions a gradual improvement may be seen. While some doctors use fillers in this area I avoid them as their is an increased risk for blindness when using fillers in this area. Skin tightening treatments such as fractional CO2 lasers can help tighten the skin overlying the muscle and further smoother out wrinkles.  Please consult with a doctor for specific recommendations. Good luck!

Alex Eshaghian, MD, PhD
Encino Physician
5.0 out of 5 stars 3 reviews

Botox and Glabella lines/Forehead

This area of the glabella is the most popular area to have Botox injected.  Because this line is already quite deep it will take consistent injections over time to flatten this line out. I would also suggest a small amount of filler in this area.  Please consult a board certified dermatologist with is an expert in Botox for the best cosmetic results.  Best, Dr. Green

Michele S. Green, MD
New York Dermatologist
5.0 out of 5 stars 76 reviews

Vertical crease in the central forehead - this can be fixed

Thanks for sharing your photo.  The line that you describe can be treated with products like Botox or Dysport. Botox should be injected into the glabellar area to help reduce movement of the underlying facial muscles that create this crease.  This may be enough to remove the crease, but would likely take multiple treatments.  Depending on your response to Botox, a small amount of filler may be useful to "plump" and flatten the crease once the underlying muscular issue is addressed. 

Jill C. Fichtel, MD
Columbus Dermatologic Surgeon
5.0 out of 5 stars 16 reviews

Botox for forehead lines

in our dermatology practice we use Botox for forehead lines all the time, We do not use it however to reduce tension in forehead. 

I recommend you to discuss specific issues regarding your questions with your dermatologist. 

Steven Hacker, MD
West Palm Beach Dermatologic Surgeon
5.0 out of 5 stars 4 reviews

Forehead crease


This crease will eventually soften with Botox/dysport/xeomin that is properly injected. The  typical migraine protocol does not treat this area. Like others have said, it takes multiple treatments to finally get this crease out. It is like letting down an old hem on a dress. You have to wash it and iron it over and over to finally flatten it out.  I use small amounts of soft filler to flatten if patient does not want to wait. 

Jo Herzog, MD
Birmingham Dermatologist
5.0 out of 5 stars 18 reviews

Botox and forehead crease

Thanks so much for your photo and question.  Doing regular Botox in the glabellar area (around 20 units) will eventually smooth out the crease that is causing you frustration.  It may take around a year to start seeing any real improvement with getting Botox in this area every 3-4 months, but you will see positive change.  I recommend my patients who struggle with deeper creases in their face or neck, go through a series of microneedling treatments along with receiving Botox.  Microneedling is amazing for improving skin texture/tone, minimizing lines and wrinkles, and decreasing pore size.  It takes 5 or 6 microneedling treatments spaced out about a month apart to see "wow" results.  But doing both Botox and microneedling will make your face look and feel amazing.  Wishing you all the best on your journey!

Remus Repta, MD
Scottsdale Plastic Surgeon
4.9 out of 5 stars 162 reviews

Botox for forehead line

Botox if placed correctly will help soften the line and make it look less deep. However it is partially etched into the skin, so combining Botox with filler, RF-microneedling or laser resurfacing will give you better results. Good luck.

Renata Wix-Harris, MD
Livingston Physician
5.0 out of 5 stars 7 reviews

Glabellar crease leads to tension

I would try another physician and get Botox/Dysport again. The crease will improve gradually as you get serial injections (3 treatments). If you can't wait that long, some docs inject the crease with fillers. There are risk associated with injecting this area including vascular occlusion. I usually don't do the fillers and tell patients that it will gradual improve as they get more treatments. It needs to be treated every 3-4 months for best results, not just once.

Steven F. Weiner, MD
Panama City Facial Plastic Surgeon
4.7 out of 5 stars 41 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.