The face is the most visible determinant of an individual’s perceived age. A youthful forehead is characterized by smooth skin devoid of wrinkles or pigmentary changes, a short hairline-to-eyebrow distance, well-positioned eyebrows, and well-contoured temples.
In women, the eyebrows lie just above the upper margin bony eye socket and form a gentle arch toward the lateral (outer) side. In men, the eyebrows lie at the upper margin of the eye socket and are normally flat.
Aging changes in the forehead start to manifest in the third decade of life. Frown lines are vertical and oblique lines that occur in between the eyebrows and may be dynamic (appears intermittently) or static (permanently present). These wrinkles add to a person’s perceived age.
Other changes visible in an aging forehead include a receding hairline, horizontal forehead wrinkles, irregular forehead contour, low-lying eyebrows, upper eyelid hooding, and hollow temples contribute to an aged forehead appearance. Individuals with an aged upper face are often described as angry, frowning, or appear tired.
Frown lines are the result of repeated long-term action of two groups of muscles: the procerus muscle and the corrugator supercilii muscles. The procerus muscle is a small muscle in the midline of the nasal root and forehead and depresses the eyebrows. The corrugator supercilii muscles lie on either side of the nose, and pull the eyebrows downwards and inwards. They produce the typical vertical and oblique frown lines.
These muscles are thicker and stronger in men and usually require higher doses of botulinum toxin than females.
The optimal treatment for frown lines depends on their severity, the individual anatomy and treatment goals. There are two common treatment methods: botox (botulinum toxin) injection, and frown muscle excision surgery. Both are effective and safe treatments in experienced hands.
Successful forehead rejuvenation reverses these aging changes and improves self-confidence and social functioning.
Frown lines are reliably treated with botulinum toxin injection and attain a high degree of satisfaction in most cases. The popularity of botulinum toxin injection has grown rapidly since the 1990s, and it is now one of the most commonly administered procedures in the world.
Individuals with shallow, dynamic wrinkles, and are willing to have repeat treatments are ideal candidates for botulinum toxin injection.
We frequently see or hear of people who look unnatural following aesthetic treatments. This is often due to practitioners who attempt to reverse all the signs of aging by using botulinum toxin alone, resulting in stiff and unnatural results. Botulinum toxin does not reverse skin and muscle laxity or fat atrophy. Attaining bespoke and attractive results that retain an individual’s expressivity is frequently possible and requires accurate assessment, appropriate product choice, precise administration by an experienced practitioner.
Botulinum toxin causes partial weakening of the procerus and corrugator muscles that are involved in the formation of frown lines. The number of injections and the dose are determined by individual anatomy and the gender. Males generally require higher doses of botulinum toxin for optimal result.
The effects of botulinum toxin take 1 to 3 days to be observed, and will last for 4 to 6 months. Repeat treatments are necessary for maintenance of the result.
Individuals are advised to avoid vigorous massage to the treatment area for 2 hours following the injection. This is to prevent spread of the botulinum toxin, which may result in potential unintended adjacent muscle paralysis. Individuals may resume their usual activities immediately following the procedure.
Corrugator myectomy produces sustained and elegant reduction of the frown lines. It is performed through an incision in the double eyelid crease and is often performed together with surgery for droopy upper eyelids. Corrugator myectomy is an ambulatory procedure performed under local anesthesia, with optional intravenous sedation if requested.
Individuals with any severity of frown lines and desire long-term improvement may consider surgical frown muscle excision. Individuals who have deep and fixed frown lines, or have had suboptimal results from botulinum toxin treatment will benefit most from corrugator myectomy surgery.
Corrugator myectomy will deliver sustained reduction of frown lines. The incision is made in the double eyelid crease, and the scar is well-concealed when healed.
Individuals are advised to stop herbal supplements and traditional medicine and start special medications 7 days prior to surgery to minimize bruising and swelling.
Local anesthesia is infiltrated into the operative site for optimal intra- and post- operative analgesia. An incision is performed within the double eyelid crease. A tunnel is made beneath the eyelid skin to facilitate access to the upper bony eye socket. The corrugator muscles lie just above the eye socket and are identified then excised. A small piece of fat is frequently obtained from the brow region and is sutured to the cut muscle edges to prevent muscle regrowth and frown line recurrence. The wound is closed meticulously to minimize the scarring for optimal postoperative results.
Mild bruising and swelling is expected, which will mostly resolve by the 5th postoperative day. Stitches are removed on the 7th postoperative day and most individuals are able to return to work following their removal.
Postoperative swelling is reduced by remaining upright during the daytime and by elevating the head of the bed with extra pillows when asleep at night. Gentle face washing is possible from the second postoperative day onwards. Strenuous activity should be avoided for the first two weeks to minimize bruising.