Forehead wrinkles treatment is one of the most popular treatments at our Sydney clinic.
The most superior treatment for horizontal forehead lines is muscle relaxing injections (due to Australian regulations, we are not allowed to name the drugs used). We also love to use skin boosters in this area (related to dermal fillers)
Small injections using a very fine needle are performed to the forehead into the muscles which causes the eyebrows to be raised (frontalis). Somewhere between 6-16 injections will be performed.
Doctors have to be skilled in this area, as this area has the highest risk for brow droop. The other issue is that when assessing the harmony of the face, the size of the forehead is important for beauty and age appearance. If the patient with difficult anatomy has incorrect placement or dose, they will look older or less attractive.
See these posts for frown line treatments or forehead filler
Forehead wrinkles treatment
The consultation for antiwrinkle injections for horizontal forehead lines
History-taking is very important in the treatment of horizontal forehead lines. The following should be explored:
- How large if the forehead. Are there sagging upper eyelids?. How have these progressed?
- Has the patient had treatment before? Were they happy with the treatment? Were there complications eg eyelid droop or eyebrow droop or “spocking”.
- Did the effect of the antiwrinkle injections last well? Which area came back first?
- How is the patient’s metabolism? Do they exercise? Are they very muscular? Do they have trouble putting on or losing weight?
- Is it the vertical frown line, or the horizontal line between the brows which are bothering the patient.
- Does the patient want a more natural appearance, with some movement left, or do they want the maximal effect possible?
The doctor will examine the face and horizontal forehead lines. In particular, she will look at many features, such as:
- Where the lines are.
- Whether there is any eyelid droop or asymmetry
- The size and particular height of the forehead compared to the other thirds of the face
- Whether the horizontal forehead lines are etched in at rest.
- The type of skin, whether there is fine wrinkling or deeper wrinkling
- How is the brow position. Does the patient need a brow lift or an upper blepharoplasty
Choosing the number of units for forehead wrinkles
The doctor will assess the face and decide on the best dose after taking a history and examining the patient.
- If the patient has a history of poor longevity, or needing high doses or wanting maximal effect, then a higher dose may be suggested
- If a patient has a history of complications with muscle relaxing injections, or if their budget is small or if they want a more subtle result, then a smaller dose might be chosen.
- If a patient has a history of eyebrow droop, then a small dose would be recommended
Pain relief during treatment
A numbing cream (eg EMLA or LMX ) may be applied to the area prior to the treatment (45 minutes prior is ideal) Glad wrap may be used over the numbing cream to increase its effect.
Most patients do not bother with numbing cream because it takes so long to work and because the treatment isn’t very painful anyway.
Ice is usually used to decrease pain and to reduce the risk of bruising.
Nitrous Oxide (Happy Gas) is available for use.
If the patient requires a skin booster or a dermal filler, local anaesthetic may also be used prior to treatment
The forehead wrinkles treatment
The face will be cleaned with alcohol or chlorhexidine.
Ice will be applied to the area briefly before treatment
The doctor will inject approx 6-16 sites around the forehead above the brows, injecting in the muscles which cause the eyebrows to raise ie the frontalis muscle. Then pressure with gauze will be applied.
The procedure itself takes less than 5 minutes.
Risks and side effects of forehead wrinkles treatment
In general, treatment of the horizontal forehead lines is very low risk.
- Headache happens in around 10% of new users.
- Bruising occurs in a significant number of cases.
- Mild swelling around the injection sites is common, and doesn’t last very long
- Asymmetry: Often one side is better treated than the other, this is usually because the patient is asymmetrical to start with.
- Infection is a very rare complication, but always a possibility when the needle goes into the skin.
- Eyelid droop and eyebrow droop are possible risks with treatment of horizontal forehead lines. It is very uncommon and in our practice below 0.5% over the last decade which is much lower than the stated rate. The risk increases with larger doses.
- “Spocking” is common, and occurs often because the injector is being careful to avoid a brow droop in the outer corners of the eyebrow, by not injecting too close to that part of the frontalis muscle which raises the outer brows. The brow droop is avoided, but the reverse can occur with the forehead being generally smooth and unable to move, except for the areas above the outer brows which can pull the outer brows up giving a strange appearance.
Who is unsuitable for treatment for horizontal forehead lines?
There are some patients who will be unsuitable for horizontal forehead line treatments eg those who really need a blepharoplasty, with excessive upper eyelid skin hanging down over their eyes. If the horizontal forehead lines are treated in these people, any minor droop in their lids is going to be a problem.
Sometimes patients with very large foreheads or receding hairlines don’t like the treatment because when it relaxes the forehead, the forehead can appear larger and the hairline back even further
After forehead wrinkles treatment
Instructions for care after horizontal forehead lines injections
- No makeup for 4 hours
- No massage that day
- No heavy exercise that day
- No lying down for 4 hours
- Lots of eyebrow raising is suggested for a few hours
- Avoid active or acid face products for 24 hours
What to expect after horizontal forehead line treatment?
Immediately after sometimes there is nothing to see. Sometimes there can be redness, bruising, small lumps, which can look like mild acne and usually resolve quite quickly.
Most people could come during their lunch break during work and go back without their coworkers noticing anything
The effect of the injections may start to occur in 2-8 days.
The maximal effect of the injections will be at 4 weeks, so a review should be booked in at 4 weeks (only after the first treatment, for subsequent injections, a review appointment shouldn’t be required)
What if I get asymmetry or “spocking” at some time before the 4 week point? Do I call the doctor?
No. No need to call the doctor. Sometimes asymmetry will occur because one side just comes on quicker than the other. Usually it will right itself by the time of the review appointment. If it doesn’t, then it can be treated at the review appointment. There is no point in coming in early for treatment of asymmetry. Treating asymmetry or spocking too early could lead to droop or further asymmetry. It is best to wait for 4 weeks for a review appointment
Do I call the doctor if I get brow droop?
Yes, organise a review appointment if this occurs.
What do I do if at 4 weeks post treatment I still have movement or etched in lines?
This is not uncommon, it really depends on the amount of movement and the look you are going for.
Patients often come in and they only have 5% of movement left and are concerned about this. We believe that a little bit of movement is not a bad thing. The wrinkles are still improved when there’s 5% movement, there’s just a small amount of movement, which is fine. You don’t look older or worse in any way. In fact, you will look slightly more “natural” with more movement. We would like patients to move away from complete loss of movement as their goal. The goal should be to look younger and more attractive.
However, it is up to the individual, and further treatment can be performed at 4 weeks.
Dermal filler or skin boosters for the horizontal forehead lines can be considered at this stage if the lines are still etched in
How long will the forehead wrinkles treatment last?
The answer to this is very individual and depends on the patient’s metabolism, the dose, the placement etc.
Typically this is what happens:
At 3-4 weeks, there is a maximal effect
at 8 weeks, movement starts to return
at 12 weeks, 50% of movement should be back
at 16 weeks 80% of movement should be back.
For most patients, this is very close to what occurs.
When should I have my next forehead wrinkles treatment.
Patients should be retreated when the movement is between 50%-80% back ie sometime from 3-4 months.
Some patients have treatment every 8 weeks as they do not like movement
Price for antiwrinkle injections in horizontal forehead lines
Typically cost is from $390. If other areas being treated as well, then this will bring the cost down