The horizontal forehead lines, or “brow furrows”, happen due to action of the frontalis muscle, which raises the brow.
My first line treatment here is a light treatment of a neuromodulator (such as Botox, Dysport, Jeuveau, or Xeomin), with an emphasis on “light”. I typically treat this area with 10 Units of any of the products, leaving some motion so that the face still has the ability to show emotion. The brow naturally raises during certain parts of speech and when the face is trying to convey certain emotions. My goal is to preserve the showing of emotion while reducing the motion so that the muscle is not “overactive”. For patients with tall or strong foreheads, a touch-up treatment 2 weeks after the first treatment may be necessary.
Overtreating of the forehead lines can lead to the drooping of the brow, and this is avoided by treating the higher part of the muscle and also leaving enough muscle active so that it can hold the brow in its correct position.
After the muscle motion has been treated, a few patients have deep lines etched into the skin, and these lines can be treated with a small amount of filler to improve the contour. I ideally reduce the motion using a neuromodulator, wait two weeks, and then treat with the filler.
Neuromodulator treatments in the office take 15 minutes (most of which is spent talking about the treatment and expectations), and the effects are seen as early as 2 days, and by 2 weeks, all of the effects have taken place. The duration of treatment typically ranges from 3-6 months, depending on the individual patient and dose used. Sometimes the forehead lines start to return prior to other areas treated, as it is treated with a low dose. I do not like treating with a higher dose for the sake of better longevity, as I want my patients to “look better” rather than “look worse for a longer period of time”. That is, I do not want to sacrifice the aesthetic look for the sake of longevity. If the other areas treated still show good effects but the forehead alone has gained motion, then I treat just the forehead and can treat the other areas once the motion has started to return.