The forehead ages by developing horizontal lines that run across it, frown lines between the eyebrows, and discolored skin with a rough texture. Our forehead ages by the same facial aging process that leads to an aged appearance in the rest of our face.
Horizontal forehead lines and frown lines develop from repetitive movement of the muscles of facial expression. These muscles allow us to raise our eyebrows and frown them. Over time, the lines created by these movements become etched in our skin. It’s like your mom used to say, “If you make that face long enough, it will become stuck that way.”
Forehead lines usually start to become etched in sometime in the late 30’s. However, this age can vary considerably depending on the person, their genetic tendency, and how much their skin is damaged. Therefore, it is best to start treatment before they become etched in. Even if lines are etched in, though, I have seen them soften in patients who have been diligent about getting Botox over the years.
Some people are born with the tendency to get horizontal forehead lines very young in life. This is usually a family trait, and patients often notice deep lines in a parent.
Aside from horizontal and frown lines, some people can also develop diagonal lines toward the sides of their forehead, and they can develop comma shaped lines just above the end of each eyebrow.
The most effective way to treat all of these forehead lines is using a neurotoxin. These include Botox, Xeomin, and Dysport. There are slight differences between each of these products, but it is hard to say which is better. Botox, Xeomin, and Dysport all work by limiting the muscle’s ability to move the skin which creates the line in the first place.
Botox, and the other neurotoxins, do not do anything for the tone and texture of the skin, however. These are best treated by using one or a combination of prescription creams, fractional laser resurfacing, IPL, chemical peels, electrocautery, and/or liquid nitrogen depending on what is causing the discoloration and textural irregularities. Similarly, these treatments do not help much with the lines of the forehead.