Botox® or Filler for forehead lines (or both!)

Forehead lines can be some of the first wrinkles patients notice. Wrinkles of the forehead and around the eyes may make one look tired or angry. Smoother skin is goal for others seeking treatment. Regardless of the reasons treatment, improving forehead lines is common in a cosmetic surgery practice.

Botox for forehead lines

Botox has been the most popular treatment to soften forehead wrinkles for years. Another more recent option is Dysport®, which works in a similar fashion. Both of these treat wrinkles by relaxing the muscles that contribute to wrinkles. Once the muscle is relaxed, the skin relaxes and appears smoother.

Botox and Dysport have been used for both the horizontal and vertical forehead lines. These wrinkle relaxers don’t work right away. It usually takes a few days to kick in, and then lasts about three months. Patients come about four times a year to the plastic surgeon’s office for Botox and Dysport.

Facial fillers for forehead lines

Facial fillers are hyaluronic acid gels that are injected into the skin and tissue. Facial fillers are very popular as part of a liquid facelift for several areas such as the smile lines, lips, and cheeks. These treatments can improve wrinkles by adding volume to a depressed wrinkle.

Facial fillers have been also been used for the horizontal and vertical forehead lines. Facial fillers work immediately, but may take a few days to “settle” and integrate with the tissue. Facial fillers last approximately 6 months around the mouth and lips, but usually last much longer around the eyes and forehead. Patients can get over a year for cosmetic improvement from facial fillers.

Examples of facial fillers include Belotero®, Juvederm®, and Restylane®. There are several sub-types of the facial fillers with various characteristics (ex. thickness) that plastic surgeons utilize for specific areas or treatments. For example, plastic surgeons are more likely to use very thin fillers for forehead lines, while thicker fillers to volumize the temple and cheek areas.

Best treatment for forehead lines?

Botox and Dysport are generally the first choice to relax the forehead wrinkles for many patients and plastic surgeons. Fillers are typically not the first choice for these lines. Some patients, however, need combination treatment for enhanced results.

The patient in the video above didn’t want to relax the forehead wrinkles with Botox or Dysport, as the brow was already low. In addition, the patient wasn’t able to return every three months as required for Botox and Dysport. This patient preferred the effect of facial fillers on the forehead and would come approximately yearly for treatment.

One potential issue with Botox and Dysport is that the brow can relax along with wrinkles and subsequently droop. While plastic surgeons can attempt to lift the brow with these wrinkle relaxers, a change in brow shape and/or shape is possible with Botox and Dysport. Facial fillers generally don’t change the brow.

As with all plastic surgery, there isn’t a “best” option. Some patients and doctors may prefer one over the other. Patients who have significant forehead wrinkles may be better surgical candidates, such as brow lift or eyelid surgery.

The best plastic surgeons will utilize a variety of aesthetic techniques to enhance the face and skin, while promoting safe and natural results. The decision to how to improve forehead lines is based on multiple factors, including a patient’s specific anatomy and personal preferences.

Questions about cosmetic treatment of forehead lines? Share your thoughts below.