Forehead lines: treatment options

Key takeaways

• Forehead lines are mostly caused by the frontalis muscle, which lifts the brows every time you look surprised or raise your eyes.
• Some people lift their brows all day without realising, often to compensate for heavy upper eyelids.
• Anti-wrinkle injections soften movement lines; skin-quality treatments help lines that are etched in.
• The forehead is where an overdone result shows quickly. Restraint matters.
• Frown lines between the brows are a separate muscle and are often treated together.

Why do forehead lines form?

See, what happens is, the forehead has one main muscle, the frontalis, which lifts the eyebrows. Every time you raise your brows, it folds the forehead skin into horizontal lines. Over years, as the skin loses collagen and is exposed to sun, those folds remain even when your face is still.

There is something else I look for. Some people raise their brows constantly, without knowing, because their upper eyelids feel heavy. The forehead muscle is basically holding their eyes open. That is very important to understand, because if I relax that muscle completely, the brows can drop and the eyelids feel heavier. So before treating any forehead, I look at the eyelids and brows.

What can I do at home?

• Daily sunscreen on the forehead, which gets direct overhead sun. In Mumbai, that is most of the year.
• A retinoid at night, which has randomised trial evidence for fine wrinkles (retinoids for anti-ageing).
• Moisturiser, which Mayo Clinic notes temporarily plumps skin and softens the look of fine lines.
• Notice your habits. Raising your brows while reading screens, or squinting without glasses, adds to the folds.

How do anti-wrinkle injections work on the forehead?

Small doses of botulinum toxin are injected into the frontalis to reduce how strongly it contracts. Mayo Clinic lists forehead lines among the lines where these injections work best, and the American Society for Dermatologic Surgery lists forehead furrows and frown lines among the main uses.

Why do some people end up with heavy brows or a shiny, frozen forehead?

Usually from too much product, product placed too low, or treating the forehead without treating the frown muscles that pull the brows down. The dose is the skill. My approach is to: - Keep injections well above the brows - Use a lower dose than you might expect, especially at the first session - Leave some movement, so you can still look surprised - Review at about two weeks and adjust next time, rather than overdoing it on day one

A clinical review in the PMFA Journal notes that in men, a low, flat brow is the natural shape, and that complete removal of forehead lines and excessive arching look unnatural. I keep that in mind for everyone, not only men. Our article on why some faces look overdone explains this further.

What about lines that stay even when my face is relaxed?

Injections reduce movement, so etched lines often soften over a few treatment cycles. But deeper static lines also need work on the skin itself: - Laser treatments, chosen and set carefully for Indian skin because of pigment risk. See laser treatments for fine lines and texture. - Chemical peels, in suitable skin. - Radio frequency, sometimes, for firmness.

What about fillers? The US FDA lists the forehead among areas where dermal fillers are not FDA-approved, and the forehead has blood vessels where accidental injection can be serious. I am very cautious here, and for most people I do not use filler in forehead lines.

Who should not have forehead injections?

• Pregnant or breastfeeding women
• People with certain nerve or muscle conditions, or on some medicines. Tell me everything you take.
• People with very heavy upper eyelids, where the forehead is holding the eyes open. They may be better with a very small dose, or a different plan, or an eyelid assessment.
• Anyone with an infection or active skin problem on the forehead

How do I plan forehead treatment over the years?

Normally I start by asking how much movement you want to keep. Actors and teachers often want more expression. Some people want very smooth skin. That is your call. I will tell you what I would do.

Then: 1. Protect: sunscreen, a retinoid, and attention to habits. 2. Restore: a conservative dose of injections, plus a skin treatment if lines are etched. 3. Maintain: repeat when movement returns, often a few times a year, or less often if you prefer a softer result with some lines.

Forehead lines often come with crow's feet and frown lines between the brows. Planning them together keeps the face balanced, because relaxing one area while leaving the others very active can change how your expressions look.

How we approach this at Dr Tvacha

At a face assessment within the Long Game Anti-ageing Plan, I look at your forehead at rest, when you raise your brows and when you frown, and check your eyelids and brow position before suggesting anything. If injections suit you, the product and dose are written down before treatment and the fee is quoted. If a smaller step or waiting is better, I will say so.

Written by

Dr Amit KarkhanisAesthetic Physician · MBBS, Dip. Dermatology (UK) · Reg. No. 2001/02/1124

Founder of Dr Tvacha, practising in Thane since 2005. Leads the weight loss and hair programmes.