Treating forehead lines

The horizontal lines across your forehead are made by the frontalis, a broad flat sheet of muscle that runs from the hairline down to the brow. It is the only muscle in the face that raises the eyebrows. Everything else in that region — the muscles between the brows and the ones at the outer corner of the eye — pulls them down.

That asymmetry is the whole problem. Relax the frontalis heavily on its own and you have removed the only lifting force while leaving all the lowering forces intact, and the brow settles lower. On someone whose brow position was already low, or whose upper eyelid skin is heavy, that reads as a hooded, tired look — and it is the single most common complaint I hear about treatment performed elsewhere.

Treating the frontalis and the depressor muscles together, in proportion, is what keeps the brow where it was. It is also why a competent injector will look at your brow position before they look at your lines.

Raise your eyebrows in a mirror, then relax completely. The lines that vanish when you relax are dynamic, caused purely by movement, and they respond well to muscle relaxing. The lines still visible at rest are static — the skin has been creased often enough that the crease persists — and relaxing the muscle will soften them but not erase them.

Static lines need the skin itself treated, which means collagen stimulation over time: microneedling, a good topical routine with a retinoid, and patience. Relaxing the muscle stops them deepening, which is the more valuable half of the deal even when it is the less visible one.

This is worth being clear about before treatment, because the disappointment I most often meet is someone who expected a set line to disappear and was not told it would not. If your lines are deep at rest, expect improvement rather than erasure, and expect it over months rather than at two weeks.

A completely motionless forehead is not a natural look and it is not the goal. Some movement in the frontalis is what makes a face read as expressive, and most people who have had a frozen forehead describe it as feeling heavy rather than smooth.

I generally start conservatively on a first forehead treatment and review at two weeks. Adding a little more is straightforward; waiting three months for too much to wear off is not, and a dropped brow cannot be corrected on the day.

Small foreheads, low brows and heavy upper lids are all reasons to treat lightly or, occasionally, not at all. Where the brow is already sitting low, treating the forehead can make someone look worse rather than better, and saying so at consultation is part of the job.

Treatment takes about ten minutes. The needle is very fine and most people find the forehead one of the more comfortable areas. There is no anaesthetic needed and no downtime beyond the general advice to stay upright for four hours, avoid the gym that day, and not rub or massage the area.

Nothing happens for the first three to four days. Movement begins to reduce from around day four, and the effect is complete at around two weeks — which is when I review, and when any adjustment is made.

It lasts three to four months for most people. Regular treatment at sensible intervals tends to extend that over time as the muscle becomes less strong; over-frequent treatment does not, and carries its own problems.

Skin quality matters more on the forehead than people assume, because the skin there is thin and takes a lot of ultraviolet exposure. Daily sunscreen and a retinoid do more for the static component of forehead lines than any injectable, and they cost less.

Microneedling can be used across the forehead to remodel set creases, generally as a course rather than a single session and generally alongside muscle relaxing rather than instead of it.

Filler is very rarely appropriate in the forehead itself. It is a high-risk area vascularly and the results are frequently poor, so if it is offered to you casually, ask a great many questions first.