What is being treated

Horizontal creases and wrinkles at the top of the nose and across the forehead, and vertical wrinkles between the brows (sometimes called “11 lines”).

How to reduce forehead and brow wrinkles

-Avoidance of sun and smoke

-Botulinum toxin

Also known by brand names Botox, Dysport, or Xeomin, botulinum toxin is a purified protein that causes localized muscle relaxation via injection of small amounts of the protein suspended in liquid to the site of muscle action that is responsible for the wrinkle.  Botulinum treatment is the most profound method of treating dynamic wrinkles around the eyes (crow’s feet, glabella, forehead).

The muscles targeted by botulinum toxin that reduce “11 lines” between the brows are the corrugator muscles.  The horizontal line at the top of the nose is reduced by treating the procerus muscle with botulinum.  The corrugator and procerus muscles (along with the orbicularis oculi muscle) work together to pull the brow downward.  For this reason they are called the brow depressor muscles.  Selective relaxation of these muscles by botulinum causes brow elevation or a non-surgical brow lift.

Lines that travel horizontally across the forehead can be reduced by treating the brow-lifting muscle called the frontalis muscle.  The potentially negative impact of relaxing the brow elevator muscle is heaviness or drooping of the eyebrows because the lifting ability of the frontalis muscle becomes impaired with botulinum treatments.  It is often recommended to lightly treat the frontalis or not treat it at all.  Treatment of the brow depressors alone can lead to a secondary softening of the horizontal forehead wrinkles.

Proper administration of botulinum injections can result in a natural-appearing wrinkle reduction without over-arching of the eyebrow or drooping of the eyebrow.

Botulinum treatment results typically last for 3-6 months.

-Filler treatments

Volumizing injections, most commonly with cross-linked hyaluronic acid gel can help to lift wrinkles and reduce the depth of furrows.  If the cause of the wrinkles are primarily due to muscle action, fillers will only partially correct the wrinkles and botulinum treatment may be necessary for a more complete correction.

Skin resurfacing

Treatments that resurface the skin (laser resurfacing, chemical peels) improve the quality of sun-damaged areas and reduce the appearance of wrinkles.  Resurfacing can be somewhat effective in the brow/forehead areas.

-Identification of underlying issues

In cases where hooded eyelid skin, droopy eyelids, or droopy eyebrows are present, an individual may use the forehead lifting muscle (frontalis muscle) to compensate for the sagging area.  If the root cause is corrected (eyelid lift, ptosis repair, brow lift), the overactive forehead muscle relaxes and the wrinkles become less prominent.

Dr. brett kotlus cosmetic oculoplastic nyc botox eyes

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