Updated: Jan 6, 2021
So you're considering treating the lines on your upper forehead? Continue reading to learn everything you need to know to before getting an upper forehead tox treatment.
What is Botulinum Toxin?
Botulinum toxin is a neurotoxin that has been prepared to relax or fully paralyze specific muscles they are injected into. How does the paralysis happen? The muscle contracting transmitters can't get out of their uber to get to the muscle, so they go back home. This causes no damage to any structures of the nervous or musculoskeletal system.
Botox, Dysport, Xeomin, and Jeuveau, are Botulinum Toxin Type A brands used for cosmetic indications. Just like Kleenex, we often refer to the treatment as the brand name, Botox. "I'm going to get Botox." "Pass me the Kleenex." What we mean to say is, "Pass me the tissue," or, "I'm going to get Botulinum Toxin type A injected in certain muscles to relax them so they do not make wrinkles."
How Does Tox Make Upper Forehead Lines Go Away?
Botox relaxes muscles. Botox does not remove lines directly, but stops skin from creasing, which softens the wrinkles. For example, if I crease a bedsheet every day for years, a tight crease will form. If I iron the sheet, but I don't stop creasing the sheet, the crease will not go away because the sheet keeps getting creased. We need to stop creasing the sheet. This is what Botox does.
Botox relaxes the upper forehead muscle, also known as the frontalis. The frontalis contracts upwards, and relaxes downwards. Contracting upwards creates the lines, so relaxing the muscle stops, or decreases the creasing.
Will My Lines/Wrinkles Go Away?
If your skin only creases when you contract the muscles, Botox will relax the muscles, stopping the creases made by those muscles. Lines only visible by contracting the muscles are called dynamic lines. Lines visible at all times when the muscles are fully relaxed are called static lines. Static lines will soften with time depending on a variety of factors.
If your skin has static lines, your sheet (or skin) will need some ironing treatments (skin resurfacing ie. retinol, chemical peels, lasers, microneedling), in addition to stopping the creasing (Botox). The quality of your skin (younger, older, sun-damaged, sun protected), and how long the crease has been present will determine how long it will take for the line to go away. Some wrinkles or deep creases may never go away. This is why preventative Botox, or Baby Botox, is on the rise. It stops the creasing before it happens. If the line is present at rest, the treatment is no longer preventative.
What Are The Risks of Botox In The Upper Forehead?
Injection Site Reactions
Injection site reactions are the most common risk. This includes bruising, swelling, minor pain, and sensitivity. Bruising can commonly happen in the upper forehead. Swelling does not commonly happen in the upper forehead. Pain is very limited, though sometimes I compare the pain to plucking a thick hair in the area getting treated.
Heavy or Spock Brows
Contrary to popular belief, tox above the brows does not lift them. The frontalis lifts the brows. Tox relaxes muscles. Too much tox above the brows can freeze the ability to lift the brows.
On the other hand, when the middle of the frontalis is treated and the sides above the brows are left with no tox, this can create a very lifted effect. If there is a strong natural arch to the brow, this may create Spock brows. If you do not know what a Spock brow is, google it.
If this is your first time getting upper forehead tox with your provider, your provider needs to learn how your frontalis responds to the tox, as well as how you like the response. One patient may love her Spock brows, but the next patient it may feel like it is the end of the world. Another patient may not want her brows lifted at all.
Most likely, your provider will inject less above the brows so they can move and lift, but also have a softening effect. Some patients will always crease above their brows if they have any brow movement. If you feel too lifted a few days to ten days after your appointment, have your brows softened down in a touch up. If your brows feel too heavy, the tox needs time to wear off. If the eyes have not been treated, tox can be placed in the corner of the brow to minimally provide a lift while the brows feel heavy. It is important to communicate with your provider if you felt heavy before so they can adjust placement.
Google-able Scary Side Effects
If you google "Botulinum Toxin Side Effects" or Adverse Effects, you may read some scary reactions like difficulty swallowing, breathing, or talking, severe muscle weakness, or loss of bladder control. These are systemic results that can occur when upwards of 300-400 units of tox are used. Botulinum toxin is also used for hypertonic muscle conditions, like dystonias. Full limbs are treated with multiple hundred units of tox. The likelihood of a scary adverse event happening is extremely unlikely with cosmetic dosages of tox.
With this said, most patients will never experience the scary side effects.
How Much Will Upper Forehead Line Botox Cost?
The upper forehead needs to be treated along with the lower forehead, or the muscles between the brows. If the upper forehead is treated alone, you may feel very heavy because the lower forehead muscles without tox will be able pull down, but your lifting muscles will be relaxed.
Some clinics charge by unit, while some clinics charge by area.
Most places charge by unit, and the price per unit or per area will vary based on the specialty, location, and many other factors.
Between the brows, Botox, Xeomin, and Jeuveau are FDA approved to last 3-4 months at a dose of 20 units. Dysport is FDA approval dose for 3-4 months is 50 units. 1 unit of Botox, Jeuveau, or Xeomin is compared to 2.5-3 units of Dysport.
In the upper forehead, 5-20 units may be required. 20 units are FDA approved to last 3-4 months, but often 10-12 units is an average dose.
Most men and some women with strong muscles will need more units. 20-30 units of Botox is not uncommon in the upper forehead alone. The stronger the muscle is, the more units it will need.
What Should I Do Before My Forehead Line Botox Appointment (Pre Care)?
The upper forehead is more likely to bruise, so avoiding blood thinners to prevent the risk of bruising is a good idea. Common blood thinners are alcohol, aspirin (and NSAIDs), fish oil, gingko biloba, ginseng, and garlic. If you are on a prescription blood thinner, it is possible to have injections as long as your primary care gives the okay and you are not in critical health.
If you have high anxiety or are really nervous, you may have a history of fainting with injectables, like getting needle pokes or giving blood. This is called vasovagal syncope. To avoid fainting, make sure you have eaten before the appointment, avoid coffee, and be hydrated. Communicate your fainting history to your provider. It helps to talk during the treatment, or be distracted. To avoid fainting, make sure you do not hold your breath. Relax your upper body. If you feel yourself about to faint, squeeze your abdominal muscles, and tell your provider so they can lay you down.
If you love to workout, plan your workout before your appointment. Sweating profusely is discouraged for the rest of the day, or 24 hours after tox.
What Are Upper Forehead Line Botox Appointments Like?
First your provider will assess your concern. They will estimate the amount of units and check your medical history. You should disclose any medical conditions, allergies, medications, and current pregnancy or breastfeeding information. The only people who should not get Botox are those who are pregnant, breastfeeding, severely or acutely ill, or who have some muscular weakness disorders.
They should take baseline pictures in consistent lighting of your muscles relaxed and contracted to store in your chart. They should educate you on the risks of the procedure. They should assess the characteristics of your muscles.
Your forehead will be cleaned, and the product will be injected in 3-10 injection sites each in the lower and upper forehead.
What Do Botox Injections Feel Like In The Upper Forehead?
The injection feels like a tiny pinch, maybe equivalent to plucking a thick hair in the area being injected. If the injector is heavier handed, or your tissue is very thin, you may feel a crunching sensation. This is okay, though your risk for bruising and sensitivity is increased with a more aggressive injection. You may or may not feel the fluid being injected. It has the consistency of water. It may or may not be cold. You may or may not feel a little bit of blood from this area after the injection. It is common and normal for blood to come out of an injection site, though the injection site may also not bleed.
You may feel like the treatment is working immediately, but that is just the presence of the fluid in the tissue. It takes a minimum of hours, usually a few days to begin seeing effects.
What Should I Avoid After My Treatment?
There were general rules created when tox was developed for cosmetic use. These are "do not sweat, workout, or use a sauna for 24 hours after, do not lay down for 6 hours after, and do not touch the area treated for an hour." You can also use the muscles treated more after the treatment to help the tox kick in faster.
What Does Botox Feel Like Kicked In In The Upper Forehead?
Squeeze your hand tight. This is what your muscles do without Botox. Move your hand a little bit, but don't squeeze it tight. This is what Botox feels like. You won't be able to squeeze the muscles of the area tightly. You may be able to move them, but they will not squeeze tightly.
All toxin products take ten days to fully kick in. The strength is the greatest in the beginning, and will wear off with each passing week. For some people, you may feel a little tight in the beginning. The tightness (or heaviness if you do feel heavy) will soften with the passing weeks. If you can move the muscles in the beginning (at day 10) they will be able to move more with the passing weeks.
What To Expect From My Treatment
If you express your goals and expectations to your provider, your provider should be able to educate you on if those goals and expectations are realistic or not, and what they recommend.
If you want your lines gone, you will need to fully freeze the muscles. The upper forehead is largely responsible for expressions such as excitement, happiness, and so many more. Fully freezing the upper forehead means you will have reduced facial expressions.
Some people have hereditary or genetic heavier eyelids. They need to lift their upper forehead to not feel heavy. This causes lines in the upper forehead, but these lines are the result of a function. That function is to lift the heavy eyelids or eyebrows.
Fully paralyzing the muscle may not fully get rid of your lines. If your sheet has a crease and Botox keeps the sheet flat, you may need ironing treatments to help soften the crease. Some creases may never fully go away. For most people, fully paralyzing the upper forehead does feel heavy, so less units are used (around 10-15). Most people want to be able to move your upper forehead, which means it will wear off faster.
If you want to be able to move the muscles that are treated, your treatment will not last as long. If 20 units in the upper forehead last 3-4 months, less units will last less time.
If you move too much for your liking before the three month mark, it does mean you need more units. More units will last longer. A fully frozen muscle for 3-4 months is not a realistic expectation. The effects of the treatment continually soften past the two week mark. The muscle will slowly regain movement and strength between the treatment duration.
Which Tox Product or Brand Should I Pick?
I could make a whole blog post on this topic alone. Early in my injectable career, I set out to compare every single publication on all types of toxin for cosmetic use for efficacy. I spent over half a year trying to compare all of the studies, and learned that it was impossible to compare. The indicators of efficacy such as onset, duration, or improvement in lines are defined differently in every study. Most studies are funded by pharmaceutical companies that profit off the product and have bias. There can be flaws found in every single study, or findings can be disputed. The points used in-vitro to support a product as 'the best' are also not necessarily indicative of product efficiency. I could ramble on end about this topic.
Here's my advice. I feel every patient should at some point try every product type. All of the products are so incredibly similar. Every patient has a different goal and different opinions on what they feel is the best outcome for them. Keep in mind placement of injection is greatly responsible for patient satisfaction. Placement is directly influenced by the patient's communicated expectations and feedback. Providers are also heavily influenced by the price they get the product for and politics associated with the companies. If you feel too pressured by a provider to pick a specific product, they are not the right provider for you.
Try whichever product makes you feel the most secure. Try the product the injector recommends for you. Try a different product if you weren't happy with the previous treatment (and communicate your concerns to the provider to alter their injection placement if not previously satisfied).
Am I A Good Candidate for Botox In My Upper Forehead?
You are not a candidate if you have some rare muscular disorders, expect tox to remove all of your lines, or do not accept the risks that come with the injection. You are also not a good candidate if you expect absolute perfection with your first treatment. Your first treatment is a learning experience, and you may need to communicate to your provider if you need more units or feel too heavy. It is also very possible to not enjoy what tox feels like, and will take trying it with the right provider to learn if this is the right treatment for you. If you have heavy eyelids and are not okay feeling heavy, you need to be able to be okay with the lines being softened, but not fully treated to compromise allowing movement of the upper forehead to feel comfortable.
A good candidate is someone who is looking to soften the lines on the upper forehead. They may have static or dynamic lines. They understand and consent to the risks of injection. They do not expect lines to fully eradicate immediately after tox kicks in. If they have heavy eyelids, they need to be okay feeling a little heavy. They are able to be local to the clinic ten days to two weeks later in case they need a touch up.
If you live in Southern California, specifically Los Angeles, Orange County, or San Diego, schedule to see Jasmin in Costa Mesa, California for Botulinum Toxin Forehead. Consultations are free.