Priorities
Fine lines and wrinkles
Expression lines on the forehead, between the brows, and around the eyes.
Expression lines commonly appear on the forehead, between the brows, and around the eyes. Lines that fade when your face is relaxed are caused mainly by muscle movement, and that distinction guides which treatment will work best.
These muscle lines respond well to a neuromodulator. Lines that remain when your face is still are skin lines, and those usually call for a skin treatment instead.
What we'd want you to know
A line that stays at rest needs a different approach
If your lines disappear when you stop frowning, we’d suggest starting with Botox, Dysport, Xeomin, or Jeuveau. Our nurse practitioner doses conservatively the first time and follows up with you at two weeks.
If a line is still visible when your face is relaxed, toxin can soften it but won’t erase it. In that case, we may recommend microneedling to rebuild collagen, or Morpheus8 if the skin has also thinned and loosened.
How we evaluate fine lines and wrinkles
We’ll evaluate your face both at rest and in motion. First we’ll note which lines remain while your face is relaxed, then we’ll ask you to frown, raise your brows, and squint. Comparing the two shows how much of each line comes from muscle movement and how much is in the skin itself.
For muscle lines, we use Botox and the other neuromodulators. Botox and Xeomin are approved for frown lines, forehead lines, and crow’s feet. Dysport and Jeuveau are approved for frown lines, and using them anywhere else is off-label. In Botox’s own trials, 80 percent of people had responded by day 30, per the Botox Cosmetic prescribing information. It wears off in about three to four months.
For skin lines, we recommend a texture treatment. Microneedling is the gentler place to start, with three to six sessions about a month apart and a day or two of pinkness. Morpheus8 adds radiofrequency heat through the needles and is a good option when there’s laxity along with the lines.
We don’t treat during pregnancy or breastfeeding, and toxin isn’t an option if you have a neuromuscular condition.
Your questions, answered
Should I start Botox before I have wrinkles?
Preventative treatment isn’t necessary for everyone. We recommend it when you can already see a line forming with movement. If your lines clear as soon as your face relaxes, daily sunscreen is the best prevention for now, and we can reassess when the 11s between your brows start to linger at rest.
Can Botox fix the lines that are there when my face is relaxed?
It can soften them, because the muscle stops re-creasing the skin, but it doesn’t fill the groove. A line etched in at rest needs collagen rebuilt under it, and that’s where microneedling or Morpheus8 comes in. We often start with toxin and then assess how much of the line remains.
How many units will I need for my forehead?
The appropriate number of units depends on your anatomy, muscle strength, and treatment goals, including whether we’re treating the forehead alone or with the 11s and crow’s feet. We start conservatively, since a heavy forehead dose can drop the brows, and we can add more at two weeks. Our forehead units guide covers the typical ranges.
Related treatments
From the clinic
Treatment guides · 6 min read
How many units of Botox for the forehead? (And the 11s and crow’s feet)
There isn't one number for the forehead. It's a range we set after watching your forehead move. The one standardized dose is for the frown lines…
Compare and decide · 6 min read
Dysport vs Botox: the differences that matter in the chair
Dysport and Botox are both botulinum toxin type A, and the differences that matter in the chair are smaller than many people expect. Both take a…
Compare and decide · 6 min read
Morpheus8 vs microneedling: which one you actually need
Many people who ask about Morpheus8 are better suited to microneedling with PRP. The choice usually comes down to your main concern. Loose skin (jowls, neck,…