Forehead botulinum toxin
Forehead treatment delivers 8–20 units of botulinum toxin into the frontalis — the only muscle that lifts the brow — to reduce, in a measured way, the movement that creates horizontal forehead lines.
- Procedure time
- 10–15 minutes
- Anaesthesia
- Usually not needed; topical anaesthetic cream on request
- Recovery
- Back to normal the same day
- Sessions
- One session · review at week 2
- How long it lasts
- 4–6 months
The target muscle: frontalis
Horizontal forehead lines are the work of a single muscle: frontalis. It raises the eyebrows, and every time it does, the skin above it folds over itself. Repeat the fold often enough and the line stays.
Frontalis is the only brow-lifting muscle in the face. The muscles that pull the brow down — around the glabella and the eyes — work against it. So the dose given to frontalis changes not only the forehead line but the height of your eyebrows.
The dose is not spread evenly across the whole forehead. The real borders of the muscle are marked while you raise your eyebrows; the width of frontalis and where it separates at the midline are not the same in any two people.
How the dose is calculated
The typical range for the forehead is 8–20 units. Where in that range you sit is set by the strength of the muscle, and the exact dose is determined by watching you raise your brows at examination.
In this area the dose is chosen as the lowest amount that will soften the line. A higher dose erases the line further but drops the brow; the gain and the loss meet at the same unit.
- Muscle strength — strong expression means the dose moves towards the upper end
- Forehead height — a taller forehead means a wider muscle and more injection points
- Brow position — a lower dose is chosen where the brow already sits low
- Sex — frontalis muscle mass tends to be greater in men, so the dose shifts upward
- Previous treatments — in regular repeaters the muscle weakens and the dose can come down
The day of treatment
The skin is cleaned and you are asked to raise your eyebrows so the mobile part of the muscle can be marked. The injections are usually given at 6–10 points with a very fine needle.
Total time is 10–15 minutes. Most patients need no anaesthetic; a topical cream can be left on for 20 minutes if you would prefer one. What you feel is a one- or two-second sting at each point and mild pressure.
Do not lie down or massage the area for the first four hours. Avoid exercise, saunas and alcohol the same day. The small raised bumps at the injection points settle in 15–30 minutes, so a same-day flight home is not a problem as long as you stay upright.
The timeline of the effect
The effect starts at days 3–7 and settles fully at days 10–14. It is normal for nothing to appear to happen in the first days; the result is not judged before two weeks have passed.
That is why there is a review at week two. If there is asymmetry or an area left short, a small addition is made at that review, and the added units go into your record. If you have already flown home, the review is done by photograph and message and the adjustment is planned for your next visit.
On the forehead the effect lasts 4–6 months on average. When it wears off the muscle regains its strength gradually; the line returns to how it was before treatment. It does not get worse.
What decides the result
What decides the result is not the total number of units but where they are distributed. Injections placed too close to the lower part of frontalis drop the brow; injections confined to the upper part leave the lower lines untouched.
A frozen look is not the result of the correct dose but of too much of it. The aim is to reduce movement, not end it: the brow should still lift, and the line should not deepen as it did.
If a forehead line is visible when your face is completely still, that is a static line and it comes from the skin’s own loss of structure. Botulinum toxin slows such a line from deepening further, but it does not release it on its own.
Who this is not for, and what not to expect
Botulinum toxin is a prescription medicine with its own contraindications. You need to tell us at examination about every medicine you take, every condition you have had, and any possibility of pregnancy — including anything prescribed by your GP that you may not think of as relevant.
In a patient whose brow already sits low, or whose upper eyelid skin has become lax, weakening frontalis makes the appearance heavier. In that picture the dose is reduced or the treatment is not given at all.
- Pregnancy and breastfeeding — not treated
- Neuromuscular disease (myasthenia gravis, Lambert-Eaton syndrome, motor neurone disease) — not treated
- Aminoglycoside antibiotics — they can amplify the effect of the toxin; not treated until the course is finished
- Active infection or inflammatory skin disease in the treatment area — not treated until it clears
- Known hypersensitivity to botulinum toxin — not treated
- Bleeding disorder or anticoagulant use — bruising is more likely; a doctor’s assessment is required
- A deep static forehead line will not be released by botulinum toxin alone; brow and eyelid laxity will not be corrected by it
This page is general information and does not replace a clinical examination. The method, dose and timescale that apply to you are decided by a doctor after examining you.
Frequently asked questions
How many units does forehead treatment take?
Will my eyebrows drop?
When will I see it, and how long does it last?
Will my face look expressionless?
I am flying home the same day — is that a problem?
Pre-assessment
Describe your situation and we will answer with a measurement
Send a photograph or an X-ray. A doctor in the relevant speciality will reply with a graft range, a number of teeth or a dose range in units. If you are not suitable, we say so plainly.