How do I get rid of forehead wrinkles?

Wrinkles of the forehead may be treated adequately with Botox.  If you have significant brow ptosis or thickened heavy folds, a brow lift would be beneficial.

Steven Wallach, MD

Botox is great drug with an EXCELLENT safety profile. It is one of the few drugs that can boast that it works nearly 100% of the time when used in appropriate patients with good technique. Getting rid of forehead wrinkles with Botox can be very easy, quick and painless. The results take 2-3 days to start, peak within 2 weeks and last for about 2-4 months.

However....Botox in the forehead is not good for everyone. Some people, especially those over 50 years of age, need to use their forehead muscles to hold their eyes open, especially when reading. If you are one of those people, then Botox could be a really bad idea. Too much Botox in the forehead can lead to a drooping sagging brow which can make it hard to see.

To find out if Botox would work for you in your forehead, find a doctor with a lot of experience with Botox. He should be able to evaluate your forehead and give you some guidance. Getting Botox from a place that treats everybody who can pay for Botox is asking for a disaster.

Your concerns result from a ubiquitous human condition.

• We all begin to experience descent of our eyebrows and forehead tissue generally in our late 30s.
• This leads to an unperceived blockage of our vision by upper eyelid skin.
• Unconciously, the forehead muscles contract to raise the eyebrow and eliminate the barrier to full vision.
• This vertical contraction results in the typical horizontal forehead wrinkles you mention.

Botox Cosmetic® can be injected into these muscles to smooth out the forehead but unfortunately, in many people, this can result in lowering of the brows producing and older, angrier look. Should this occur or be likely to occur if Botox is used, it can be nicely corrected with a forehead lift done through small incisions hidden behind the hairline (endoscopic).

The angry look you describe may also come from over active frowning muscles just above the nose (corrugator and procerus muscles). This problem is generally easily and very effectively managed by Botox injection in this area.

For Botox non-responders (about 4 % of the general population), or those patients who would like a more permanent correction, these muscles can be weakend at the time of endoscopic brow lifting or upper eyelid blepharoplasty.

None of these interventions, if done correctly, should produce an unnatural or frozen look.

If you don't want to do anything drastic and are looking for a simple solution, the best advice is to reduce your stress. Often premature wrinkles on the forehead are caused by stress, poor hydration, sun exposure and smoking. Mental and physical stress is a major factor in how we age.

Also, massage your forehead or a specific divot (wrinkle), which will allow blood to flow through the area faster and oxygenate the area for better health.

Breathe, relax!

By far, Botox is the best treatment to get rid of your worried/angry look.

Have fun.

Those bothersome wrinkles in the forehead that we all get as we get a bit older come primarily from the repeated movement of the forehead due to expression; these are called dynamic wrinkles. It is impossible to prevent these, but we are able to get rid of them very nicely with a little Botox. The main goal in doing this is to eliminate the deep wrinkles and lines, but not eliminate facial expression. There are too many people walking around who have overdone the Botox and look like the Stepford wives with frozen or flat expression.

It is very important to go to a well-qualified and well-trained cosmetic specialist for this treatment. There are serious adverse side effects if Botox treatment is not done by well-trained and specialist physicians, so select your doctor carefully.

Sounds like you have strong expression lines. The quickest way to get rid of these is with Botox. No downtime, 5 to 7 days and expressive wrinkles are dramatically reduced. The treatment has to be repeated every 3 to 4 months.

One of the concerns is "overtreatment" which leads to excessive relaxation of muscles and drooping of eyes. This can last up to 8 weeks. I personally believe in softening the wrinkles but keeping the expression. I tend to "under dose" my patients and see them back in one week. We can always do a touch up if needed.

Getting rid of forehead wrinkles depends on defining the cause of the wrinkles. Some forehead wrinkles are due to motion of the muscles of the forehead and some are due to tethering of the skin to the deeper structures in the forehead.

For instance, some people, without even realizing it, always act to pull up their eyebrows so they can see. This creates forehead wrinkles. Other people are very animated and can use their forehead muscles in making expressions which can create wrinkles.

There are several treatments for forehead wrinkles:

1. Botox - Botox works by paralyzing the muscles of the forehead. It can take 20-40Units to fully paralyze the main muscle of the forehead, the frontalis muscle. Once paralyzed, wrinkles caused by contraction of that muscle will fade. Unfortunately, they will return with return of function of the muscle.
2. Forehead or brow lift - This surgical procedure can help in two ways. First, by elevating the brow and placing it into a more natural position, some people will no longer contract the forehead muscles to elevate the brow. Second, by pulling the skin and deeper structures tighter, some wrinkles can be smoothed.
3. Ablative skin resurfacing - Using CO2 or erbium lasers, newer plasma technology, or deep chemical peels, forehead wrinkles can be improved by removing the outer layers of skin and promoting collagen tightening.
4. Fillers - Several fillers on the market today, including the popular hyaluronic acid fillers such as Juvederm, Restylane, and Perlane, can fill in individual lines. Again, this effect is temporary and would need to be repeated every 6 months to a year.
5. Microdermabrasion - This procedure is good for taking off the outer layer of skin cells and exfoliates the skin. It can help with very fine lines but is unlikely to do much for deeper wrinkles.

As always, a trained and experienced physician can determine the cause of the wrinkles and suggest a course of action likely to produce the desired results.

I'm reportedly an "angry sleeper", and while I sleep I frown. This has obviously given me deep, canyon-like frown lines from a very early age - around 16! My mom recommended sleeping with Frownies, which she read about in an article on Renee Russo (also a Frownies user). I started using them, and within about a week my frown lines were gone. Here I am in my late twenties, and still no evidence of my "angry sleeping"!!

The most simple way to resolve forehead wrinkles is to consider the use of Botox. Apart from the area between the eyebrows (frown lines), the frontalis (forehead) is the most commonly injected area in our practice - both men and women alike. Botox can relax the muscle that is causing the wrinkles; however, it cannot resolve permanent (static) wrinkles that have developed over a long period of time from using the same muscle movements that lead to the problem. The key is prevention!

For those that are still with forehead wrinkles even after utilizing Botox, the next step would be to consider fillers (Captique, Juvederm, Restylane) to fill the lines by adding volume. The same concept would apply to permanent creases/folds to the frown lines after using Botox.

1. Botox - quick and easy. Works for about 3 months and you need to repeat it regularly.
2. You could use hylauronic acid based fillers injected and they last a little longer.
3. Combination of Botox and hylauronic acid fillers works very well and I tend to find that it lasts about 6 months.
4. One of my favourites is to use Rhytec Plasma PSR, which works very well and I find it can last a few years. I usually peform two treatments at high energy levels. There is some downtime of 3-5 days.
5. Also there is the old standby of using a CO2 laser, which I do not use as much but it does provide excellent results in very light skinned patients.
6. Another choice that you may hear about soon is to use Fractionated CO2 which is great but the jury is out still.

I hope that helps.

The best way to hold off forehead wrinkles is to treat the area with Botox BEFORE they become a permanent problem.

• More significant wrinkles can be treated with Thermage and/or lasers.
• Chemical peels and fillers can also have some benefit.

The most effective non-injectable regimen that I have used is by utilizing Thermage with TotalFX. TotalFX is an amazing new treatment using a fractional CO2 laser incorporating DeepFX followed by ActiveFX therapies. There is a 4-5 day period of downtime... but the results are well worth it

I have tried many different laser and RF systems. Nothing even comes close!

It is always best to have a consultation to discuss your concerns with an experienced provider. This will allow you to make the most educated decision. However, you want to make sure they have appropriate resources to treat a multitude of problems. A "one trick pony" is not always the best option...