Botox forehead and frown line

Botox in the forehead – The classic

Injecting forehead and frown lines with Botox

Botox in the forehead is a classic in aesthetic medicine. Smoothing forehead wrinkles with Botox is very effective, because usually forehead wrinkles are of mimic origin. They appear because the muscles of the forehead contract. Every time we laugh or frown. Botox in the forehead reduces the pull that mimic muscles exert on the skin. So Botox can be used to smooth out forehead wrinkles. And the frown line, which is often even more disturbing, at the same time. Doing both in one session also saves Botox costs. The treatment is low-risk and one of the most common cosmetic uses of Botox worldwide. As a rule, it delivers optimal results. In the following article I would like to explain how I treat forehead and forehead wrinkles with Botox in my practice in Munich.

Forehead wrinkles and frown lines are an expression of our facial expressions. They appear when we look concentrated, laugh or are angry. The frown line should actually be called a “concentration line”.

These are the subjects:

  • Smoothing forehead wrinkles – When and when not to
  • Too much Botox is not good for the forehead
  • Video: Botox forehead – glabella – eyebrows
  • Botox in the forehead – cost
  • Alternatives to Botox for forehead wrinkles
  • Frequently asked questions

Smoothing forehead wrinkles – when and when not to

Forehead wrinkles and facial expression

As mentioned at the outset, Botox in the forehead is a classic. The treatment was one of the first uses of Botox for cosmetic purposes. Nevertheless, injecting the forehead is not trivial. Because by nature, forehead wrinkles actually have a positive meaning. They appear, for example, when we listen attentively. Or when we show interest. Frown lines are immediately and clearly visible to our counterpart. By frowning, we signal active participation. This makes frown lines an important aspect of our emotional expression. And thus our individual Appearance as a human being.

Forehead wrinkles are authentic

As people, we appear authentic when our verbal and nonverbal communication match. Our interlocutors hear us verbally, but observe us nonverbally. If someone expresses that he is very sad about something, he is expected to visibly wrinkle his forehead. If he does not do this, he appears insincere. Therefore, when people say of themselves, “I am proud of my wrinkles,” they are usually alluding to their authenticity. And they are right: for an authentic and likeable appearance, functioning facial expressions cannot be underestimated. This includes the ability to form frown lines. To exaggerate: Being able to frown makes us likeable.

When do frown lines have a negative effect?

The positive impression fades, however, when forehead wrinkles appear grim or even unsympathetic. They usually do so when they are permanent and particularly pronounced. Deep furrows that stretch across from one side of the forehead to the other rarely appear sympathetic. They create a brooding, doubting impression. Just as if we were looking at our counterpart with skepticism or even contempt.

This is especially true of the central forehead crease between the eyes, which is not called the “frown line” for nothing. A deep frown line can strongly affect the image people have of you. And, by the way, the image you have of yourself as well. Thus, new research on the possible effect of Botox against depression is primarily based on results from the treatment of forehead and frown lines.

Deep forehead wrinkles look tired and saggy

Deep forehead wrinkles also signal tiredness and flabbiness. We look weary, lacking in dynamism. And look older than we actually are. Since the forehead contributes disproportionately to our appearance, this impression is even reinforced. Other, positively perceived facial expressions recede into the background when a deep frown is the first thing the other person notices.

Here again the reference to the current research on Botox in depression: Under the negative impression of deep frown lines one often suffers oneself. Cosmetic intervention in such cases therefore not only improves the external appearance. It also increases personal well-being. This is probably why having forehead wrinkles smoothed is one of the oldest cosmetic procedures. In the past, wrinkles on the forehead were removed as part of a surgical facelift. Today, Botox is usually a better option.

Botox in the forehead without great cost

The advantage of Botox into the forehead is not least due to significantly lower costs. To treat the forehead, frown lines or the entire face in one session with Botox costs only a fraction of a surgical facelift. This is still often the treatment of choice when wrinkles are not caused by facial expressions. But rather an excess of skin, as it occurs with increasing age. However, as long as forehead wrinkles are caused by facial expression, Botox in the forehead is the more effective method in terms of cost. For the treatment of forehead and frown lines, one ampoule of Botox is usually sufficient, which only costs a few hundred euros, even in Munich.

Hardly any risks with Botox

And on top of that, Botox in the forehead is the significantly less risky method. Because it makes a huge difference whether you have your forehead wrinkles smoothed out on an outpatient basis during your lunch break or in an operation with general anesthesia. Botox for forehead wrinkles takes 20 minutes, after which you are immediately ready for action. Temporary redness and minor hematoma are the primary risks. It cannot be compared to a surgical procedure at all. That is why Botox for forehead wrinkles has become one of the most common cosmetic interventions worldwide. Good results with low costs and risks simply speak for it.

Botox in the forehead as a “first time”.

For many patients who have forehead wrinkles smoothed with Botox, the treatment represents the first contact with aesthetic medicine. In my practice in Munich, I also welcome many women and men as patients for the first time when they want to have their forehead, frown lines or both injected with Botox. This does not surprise me, precisely because the forehead has such a strong part in the appearance. Even people who are skeptical of cosmetic procedures consider going to the doctor’s office. They accept the smoothing of forehead wrinkles or the reduction of frown lines, while they continue to reject lip augmentation or correction of the nose.

Beware of the “Botox forehead

However, as stated above, having your forehead wrinkles completely removed is not advisable. Because this could lead to the “Botox forehead”. A Botox forehead is completely immobile. It looks like it’s frozen in place. You would not be able to wrinkle it even if you wanted to. It would not work. A Botox forehead looks artificial. It robs you of your natural facial expression that those around you associate with you. It is probably due to the rampant youth craze that you often see the Botox forehead. In people whose forehead is no longer capable of any movement. Some colleagues even consider it a proof of their good work if the patient’s forehead has become absolutely immobile. I think this is wrong.

Preserve natural facial expressions!

Because what does it mean? Whether you laugh, whether you cry, whether you are refreshed or completely exhausted: your forehead would always appear just as smooth. A rigid Botox forehead could look very strange on your personal environment. They would not recognize you (in an emotional sense). Remember the photos and reports that were published years ago about the well-known actress Nicole Kidman were circulating? She looked artificial, they said. With a stiff Botox forehead and a frozen smile. Unappealing, according to the tenor. That’s exactly what I mean. And while you may not be a Hollywood star and no GALA or BUNTE will take notice of your looks, the people around you will. And they will certainly pay little attention to your smooth forehead, and a lot to the empathy you (also) radiate through your facial expressions.

Dynamic smoothing of forehead wrinkles

I therefore advise my patients in Munich to have forehead wrinkles smoothed only in moderation. And not to have Botox injected into the forehead in high doses. Especially not into the large forehead muscle (Frontalis muscle). This is the muscle that primarily causes forehead wrinkles. Because that would be a big step towards Botox forehead. Although you would then be wonderfully smooth as in your younger years; but at the same time you would be conspicuous with frozen facial expressions that signal a lack of empathy on all occasions.

Forehead wrinkles then when they are sympathetic

Rather, my therapeutic goal when treating forehead wrinkles with Botox is to make them dynamic to be able to evoke: If one is astonished or particularly attentive, then one can very well still show it to one’s counterpart. By raising the forehead as usual and placing it in slight transverse creases. In all other situations, however, in which they would disturb, they are not there.

No forehead wrinkles during relaxation
Dynamic smoothing of forehead wrinkles with Botox: when relaxed, the forehead is wonderfully smooth.
Botox for forehead wrinkles: When facial expressions require it, the forehead can still be wrinkled
Dynamic smoothing of forehead wrinkles with Botox: If it is required for a sympathetic-looking facial expression, then the forehead can still be placed in wrinkles despite Botox.

Too much Botox is not good for the forehead

Caveat brow ptosis!

Another risk associated with Botox overdose in the forehead is that it weakens the frontal muscle too much. The frontal muscle pulls the eyebrows upward. If its pull weakens too much, then its muscular counterparts pull the eyebrows down. In this case one speaks of Brow ptosis. It has a very disadvantageous optical effect. I will go into more detail about them below.

BOTOX against forehead wrinkles
Standard forehead injection regimen. Treatment of a pronounced “high” forehead with BOTOX may require a 2nd line of injections.

Low dose Botox for forehead wrinkles.

Whenever possible, I use a low dosage for Botox in the forehead. This preserves facial expressions and prevents excessive weakening of individual muscles, which would disrupt facial balance. Today’s standard regimen for Botox for forehead wrinkles, calls for a single line of injection. As a rule, I do not deviate from this. There are exceptions, for example, such cases when a high Forehead requires a 2nd row with injections. But otherwise it is neither necessary nor desirable.

Lower dose, lower cost for Botox in the forehead.

In the past, the dose in the standard protocol was still quite high at 30 units of toxin. Today, however, people are much more cautious. The recommended dose of Botox for the forehead is now only 13 units. That’s less than half. If the glabella and eyebrows are also treated, then an additional 30 units are required. Together, therefore, 43 units. One ampoule of Botox contains 50 units. The complete treatment of the upper face can be comfortably performed with it. Treating the entire forehead with Botox in one session is therefore attractive in terms of cost. This is because the active ingredient in one ampoule is optimally utilized, which minimizes the Botox costs per unit.

Careful dosing during initial treatment

Especially when treating new patients, I dose cautiously at first. Why? Because then I don’t yet know the intricacies of the face. I can only roughly estimate how the Botox will work. And I’d rather be wrong down than upward. This is because I can always adjust the dosage later. However, if the dose is too strong at the beginning, it can no longer be corrected.

Botox in the forehead for migraine

Sometimes, however, high doses of Botox into the forehead cannot be avoided. In the therapy of migraine, for example, they are provided. A whole 35 units according to the standard protocol. Drooping of the eyebrows is therefore considered a typical side effect. For patients who are primarily concerned with alleviating their suffering, this may not be so important. However, I still try to keep the dosage low at first. Only if the effect fails to appear will one have to choose one of two evils. And increase the dose, even at the risk of brow ptosis.

Subtly smooth forehead wrinkles with Micro-Botox

Micro-Botox, a fairly new technique, is another way to avoid ptosis and frozen Botox forehead. It involves diluting the toxin more than usual. And then injected not into the muscle, but only into the skin above it. Thus, the effect extends only over the muscle fibers that insert into the skin. The muscle itself remains untouched. In this way, forehead wrinkles can be smoothed without the risk of a rigid Botox forehead. And since injecting Botox into the skin also reduces perspiration, reduced sweating on the forehead is often a welcome additional effect.

Because of the high dilution, Micro-Botox into the forehead will not require a full vial of toxin. However, since I charge in full for each ampoule opened, it makes sense from a cost standpoint to use the remaining Botox in a location other than the forehead.

Video: Botox forehead – glabella – eyebrows

The video shows the procedure of a Botox treatment of the forehead in my practice in Munich. First the glabella is injected, followed by left forehead and eyebrow. This is followed by right forehead and eyebrow.

Muscular basics

Depressors and levators

The muscles in your face are arranged so that their forces act in opposite directions. Thus, they balance each other out. If you look at a face vertically from the front, there are muscles that lift the facial expressions (so-called Levators). And those that pull them down (Depressors).

botox forehead wrinkles - glabella - eyebrows
Standard injection scheme BOTOX forehead – glabella – eyebrows. Usually 1 ampoule of toxin is enough for this purpose, which allows the treatment of the entire forehead with BOTOX at a reasonable cost.

The large forehead muscle (Musculus frontalis), which causes the transverse wrinkles of the forehead, has a levator function: it raises the eyebrows. If you weaken it with Botox, then its upward force is neutralized. This can be just right in many cases and create a perfect expression.

In other cases, however, it can cause the opposing muscles of the brow muscle to now be too strong. We are talking about the depressors of the eyebrow region. Because the forehead muscle no longer opposes them strongly enough, their force pulls the forehead downward. With the result that the eyebrows drop. One speaks of a Brow ptosis.

Keeping muscles in balance – preventing ptosis

And brow ptosis has a very detrimental visual effect. Especially in people of advanced age. As a doctor, one must take care to keep the muscles of the upper third of the face in balance: If you weaken one, the other must also lose strength. Otherwise, the overall optical impression gets out of balance.

Don’t just treat the forehead muscle

In the specific case of forehead wrinkles, this means injecting Botox not only into the large forehead muscle. But also to treat the eyebrows and the glabella at the same time. This keeps the upper third of the face in balance. The facial expression looks natural and sympathetic. There is no danger of a rigid Botox forehead even with a combined treatment with a relatively high dose, if the doctor proceeds carefully.

No rule without exception

In some cases, however, it may be advisable not to do just that. Instead, first treat the glabella with Botox. Then wait two weeks for the full effect to take effect. And only then treat the forehead. Such an approach is recommended when it is unclear how strong the muscle of the glabella, the Musculus procerusis involved in the formation of forehead wrinkles. If it is weakened first with Botox and then it is found that the forehead wrinkles are already significantly reduced, then the treatment of the forehead muscle may no longer be necessary. At least not with the full dose. On the contrary, the normal dose in such a case could lead to the levators of the forehead region being weakened too much so that the depressors gain the upper hand, and the facial expression as a whole no longer looks coherent.

Botox in the forehead – costs

As a guideline of Botox costs for a treatment of the forehead, I can name about 280-385 euros for my practice in Munich. For this you get a whole ampoule of toxin with 50 units. This is usually enough to treat forehead wrinkles, glabella and eyebrows in one session. If you want to have your forehead treated with Micro-Botox, then it is advantageous from the point of view of cost to treat other zones as well, in order to make complete use of an opened ampoule of Botox. In this case, the guideline for costs per unit would be around 6-8 euros. On my page on Botox costs you will find more information.

Note: The calculation of the Botox costs of an individual treatment follows the physician fee schedule (GOÄ). The individual price of a Botox treatment can therefore deviate from the guideline values mentioned. It depends in particular on the amount of toxin used. Please also assume that the costs of Botox in the forehead are not usually reimbursed by GKV or PKV.

Alternatives to Botox in the forehead

A good alternative to classic Botox to the forehead, as mentioned above, is a procedure called Micro-Botox. Here, the active ingredient is injected into the skin in a stronger dilution and not into the muscle. The facial expression is not affected. However, Micro-Botox only smoothes very subtly and is therefore only suitable for relatively fresh forehead wrinkles, as long as they are not yet too deep.

In all cases where forehead wrinkles do not have a mimic origin or cannot be optimally treated with Botox due to increased muscle tone, injections with hyaluronic acid and lifting with PDO threads are suitable as principle alternatives. Depending on the specific wrinkle pattern, combinations of Botox and hyaluronic acid or thread lifting are also conceivable.

Frequently asked questions

Does Botox always help with forehead wrinkles?

No, unfortunately Botox does not help with all forehead wrinkles. There are differences in the expected results. Optimal results can be expected in patients who can cause the transverse wrinkles to appear and disappear when they voluntarily tense and relax the forehead. On the other hand, in patients who, due to a increased muscle tone (basic tension) of the forehead, the transverse wrinkles are always visible, no satisfactory result can be expected with Botox alone. In such cases, an additional or alternative injection with hyaluron is indicated. Or a lifting with PDO threads.

Can Botox also remove sleeping wrinkles?

No. Botox does not work on sleep wrinkles. This is because these vertical lines do not have muscular causes. Rather, they are caused by the skin repeatedly and persistently contracting when lying on one side during sleep. Mostly along a line that runs vertically through the forehead in the center of the eye. You can check if such a line is a sleep wrinkle by putting your hand to your cheek and forehead in front of the mirror while turning your head to the side you are sleeping on. If they are sleep wrinkles, they will be accentuated very clearly in this posture. Sleeping wrinkles on the forehead cannot be treated with Botox, but they can be significantly improved by injecting hyaluron.

What can I do about a drooping eyelid after Botox?

If you experience brow ptosis after Botox injections in the forehead, don’t be alarmed: the effect is temporary and should go away within a few weeks. Massaging the eye area with your fingertips or the back of an electric toothbrush will speed up the process. Stimulating the muscles by repeatedly opening and closing the eyes has also proven helpful. Medicinal support may include eye drops containing apraclonidine (Iopidine 5 mg/ml). This stimulates the receptors that stimulate the eye muscles to contract. It often allows the eyelid to be lifted by 2-3 mm.