Forehead Issues – Frown Lines, Drooping Eyebrows…

Here are the top issues!  A more complete discussion can be found in my book, The Surgery-Free Makeover: All You Need to Know for Great Skin and a Younger Face.

Frown lines

Frown lines on the forehead develop over the years as we contract the muscles that make us concentrate, frown or squint. Over time we develop one or two lines or grooves  between our eyebrows.

Forehead frown lines are one of the easiest problems to correct. A small amount of Botox or Dysport will relax the over active muscles (the corrugator muscle) and, over time, reduce or eliminate the wrinkles. The effect should be a relaxed, calm brow. Botox for frown lines takes about a week to work, and usually provide an excellent result. If your lines are deeper, the combination of Botox and Juvederm/Restylane is even better and lasts longer. The two are synergistic and are able to get rid of frown lines much better when combined.

And the cost of Botox for frown lines treatment is not too exorbitant either. For $200 to $600, depending on your age and the city in which you live, most people can get frown lines treated. For the first year, you will need treatments probably every 3-4 months. After that, the range is usually 4-6 months. Remember that Botox will relax the muscles that cause the wrinkle. It will take some time for the wrinkle itself to fade.

If you want the wrinkle to improve almost immediately, you will need treatment with one of the fillers—Restylane or Juvederm. Using Restylane or Juvederm fillers for frown lines to lift out and fill frown lines costs approximately $450 to $600, and the result will be immediate. A poor injector can easily over-fill this area, so find someone who is experienced. The results are not quite as good as with Botox or the two combined.

If you’re not comfortable with Botox, an alternative treatment for frown lines is the use of a filler in the frown lines wrinkles, usually Restylane or Juvederm. The filler supports the line underneath making it less visible. The muscle is still active though, so this isn’t perfect. Other Botox alternatives, like various creams and skin patches for nighttime use, despite their marketing claims, are not effective.

Horizontal forehead lines

We get horizontal forehead lines primarily from our forehead muscles contracting  when we raise our eyebrows. Some of us do this as part of our normal facial expressions and some of us (usually over 40) are using these muscles more habitually to hold our eyebrows up to make our eyes look more open.

As with frown lines, Botox is the best treatment and often gives excellent results. The cost of Botox in horizontal forehead lines ranges from about $200 to $500.  It may cost less if you’re having Botox injected somewhere else during the same appointment.

Women often look good with a smooth forehead. Men, however, look over-Botoxed (in my opinion) with a completely smooth forehead.  With most men, the goal would be to soften the lines and prevent them from deepening, not eliminate them entirely.

Scrunch and squint lines at the top of the nose

If you scrunch up your face and squint (the procerus muscle), you see the lines that form near the top of the nose. Some of us make this expression more than others, but almost all of us get these lines as we age. The ones at the top of the nose are called scrunch lines, and the ones on the side of the nose are known by the unscientific term “bunny lines.”

As with frown lines, Botox for forehead is the best treatment option for scrunch and squint lines. A little bit of Botox can produce excellent results. Costs depend on which other areas are also being treated. As with frown lines, you can reduce the wrinkle further by lifting it up with some Restylane or Juvederm.

Hollowing at the temples

One reason children have such incredibly soft, supple skin is that they have a nice soft pad of fat beneath their skin. One of the results of aging is loss of that fat pad. If you are thin, sometimes the area around your temples at the side of your forehead can become gaunt looking and create an impression of aging.

Correcting hollowing at the temples can be tricky, but it is now possible to do with Sculptra. Sculptra is a synthetic lactic acid that stimulates your production of collagen. Usually 2 or 3 treatments are needed over a period of 3-6 months to acheive the final result. For maintenance, you will need 1 treatment every 12-18 months after that.

Sculptra is not cheap. Most offices the Sculptra cost is approximately $1,000-1,500 per vial. Because of the cost, I’m not sure I would recommend opening a whole vial of Sculptra for the temples only.  But if you are having Sculptra treatments elsewhere, it makes sense to do the temple area at the same time.

Sculptra has been in use in Europe for many years, and in the United States for over 6 years. While its safety profile is very good, it needs to be injected correctly for a good result.  You will want to see a doctor who is experienced in Sculptra to ensure a good result.

Thinning hair at the temples

Men, of course, lose hair at the temples as they age.  Some post-menopausal women also experience female hair thinning and a receding hairline, particularly at the temples. For some, it may cause self-consciousness and dictate hair styles.

It may be possible to use hair extensions, weaves, or partial hair pieces.  But that depends on your particular hair and the severity of the problem. See a local hairdresser who specialized in these solutions. The Alopecia Foundation or local cancer societies often are good resources for names.  A specialist will also be able to tell you the causes of female hair thinning and what is causing your personal hair loss.

alopecia areta thinning hair for women frown lines

Hair transplantation surgery is also a possibility. It’s best to see a plastic surgeon who is a hair transplant specialist for more information on that.

I do know that many patients are happy with the results produced by Rogaine. Rogaine has been in use for many years now and is very safe. It only costs approximately $70 for a three months’ supply.  The generic version sold in places like Costco is fine to use also.

While Rogaine will not necessarily produce a luxuriant new growth of hair (it often works better in women than men), it can often add enough regrowth to lessen the problem of thinning hair at the temples. Most of my female patients apply it once a day, at night, and wash it out in the am. Rogaine must be applied daily to maintain hair growth, and must be applied once or twice a day. You should see results in 2-6 months.

There are medical conditions that cause hair loss, and you should see a dermatologist to get a medical evaluation before starting any treatment.

Drooping eyebrows

Gravity not only makes Newton’s apple fall to the ground, it also makes parts of our face droop as we get older. With the face, small improvements can make a big difference. Prove this to yourself by using your finger to lift up the outer half of your eyebrows just 1/8 inch, you will see the difference. Because the eyes are what other people see first, a little tightening and lifting around the eyes can make you look younger.

The two options for lifting the eyebrows are forehead Thermage treatments and Botox (a few drops). These two options do different things, so if you can afford it, you may want to consider both. Let’s take them one at a time.

  • Thermage forehead lift. A Thermage skin tightening treatment over the entire forehead can act to tighten the forehead skin and lift the eyebrows. Experienced Thermage practitioners will often put more pulses over the area above the outer part of the eyebrow, which gives extra lifting in that area.  A forehead Thermage treatment will cost $1,200 to $2,000, and the tightening will take effect over 2 to 6 months.  You may need two treatments initially if you are over 50 to see the Thermage results.
  • Botox. There is a little muscle underneath the eyebrow which actually works to keep the outer half of the eyebrow down. A small amount of Botox relaxes that muscle and causes the outer half of the eyebrow to lift a bit. Like all Botox injections, the result wears off after 3 to 6 months, but a few millimeters of lift from the Botox can make the eyes appear more open.  Usually this is combined with Botox treatments on other areas of the face

See Dr. Irwin’s Guide to Botox for more information.

Brown spots on your forehead from age and sun damage

Brown spots on the face are essentially sun damage. You may have had them as freckles when you were younger, but they get larger and often darker as you get older. Be sure they are checked by a dermatologist first to make sure they are not skin cancer.

The first thing to do about brown spots and age spots on the face is to prevent more of them by sunscreening. Make sure you use a protective sunscreen that blocks UVA radiation by having at least 5-10% zinc or titanium. And, wear a hat!

See Dr. Irwin’s article on Sunscreens.

You can also try over-the-counter bleaching creams if your age spots are recent and not too dark. The “bleaching” creams are 2% hydroquinone. There have been some questions raised about the safety of hydroquinones in Europe and the European Union has banned them. Drugstore “bleaching” creams will cost under $50 and take effect in about 30 days. Prescription bleaching creams are usually 4% hydroquinone and will cost under $150, with some insurance plans covering them. Hydroquinones should be used for no more than 3 months unless under the care of a dermatologist.

Bear in mind that continued sun exposure will stimulate the growth of brown spots, so that the bleaching creams will not protect you against the regrowth of brown spots or the development of new ones.

There are also plant-based bleaching creams. These ingredients are ones like arbutin, thymol, and kojic acid. You are welcome to try them but they are less effective than prescription products.

Microdermabrasion and peels are also options for brown spots. A good aesthetician can perform microdermabrasion or a low-strength peel, and these can often give good results as long as the problem is minimal to moderate at a cost under $250. Usually a series is needed.

The most effective treatment option for brown spots is a series of laser treatments. This is also, unfortunately, the most expensive. An IPL or a Q-switched YAG laser, for example, can give excellent results. Fractional lasers are a good option if your problem is more severe or you have wrinkles or acne scars that would also benefit from a fractional laser.

A series of five laser treatments for brown spots with an IPL will cost you anywhere from $1,000 to $2,500, but often an IPL will also reduce any redness, stimulate some mild collagen growth, and add to your skin’s glow. You will need maintenance treatments when brown spots reappear, or once or twice a year. Fractional lasers are more expensive, with one treatment costing anywhere from $900 to $1,900, depending on how much of your face and chest you have treated.

Brown spots or splotches on your forehead due to melasma

If your brown spots tend to be larger splotches that appear on the cheeks, jaw line, upper lip, or forehead they may be due to melasma from preganacy, oral contraceptives or other hormones. If you think you might have melasma on face, you should see a dermatologist before trying any melasma treatments. This can be a tough problem to treat and the sooner you start the better the treatment for melasma will work.

You should also see a dermatologist before receiving any laser for melasma. Some laser treatments for melasma can make it worse. One promising development is the fractional lasers, which may be helpful.

Lumps, bumps, and moles on the forehead

You should see a dermatologist if you have any lumps, bumps, or moles that you want treated. Some growths may be precancerous or cancerous, so make sure that a dermatologist checks anything that you think has changed or is suspicious. The various lumps, bumps, and moles we have are all treated in different ways depending on what they are. It is best to see your doctor to decide on the right course for you.

Next, learn about Nose Issues

See Dr. Irwin’s expert answers to other reader’s questions on Foreheads:
Is it possible to relax forehead lines and lift the brow with Botox?
I’m doing fine with Retin A (tretinoin) everywhere except one spot on my forehead.