Priorities
Fine lines and wrinkles
Expression lines on the forehead, between the brows, and around the eyes.
Starting at $10 a unit
The short version
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.
Why it happens
Why lines form where they do
Most lines on the upper face start with movement. Every frown, squint and raised brow folds the skin in the same place, and over the years, as collagen thins and sun adds up, some of those folds stop smoothing out when your face relaxes.
Movement makes the first lines
Frown lines, forehead lines and crow's feet come from small muscle contractions that crease the skin each time you make an expression.
Collagen thins with time
As the deeper layer of your skin thins with age, it holds a crease more easily and springs back more slowly.
Sun speeds it up
Years of UV exposure break down collagen and elastin early, which is why daily sunscreen matters as much as any treatment.
Sources: Cleveland Clinic, wrinkles
Your options
How we'd approach it
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Step 1We'd start with
Botox or Dysport
Starting at $10 a unit
About Botox or DysportIf 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.
-
Step 2If you need a little more
Microneedling or Morpheus8
From $347
About Microneedling or Morpheus8If 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.
Side by side
Your options side by side
The right treatment depends on whether a line comes from movement or has settled into the skin. Here's how they compare.
We'd start with
Botox and other toxins
Starting at $10 a unit
- Best for
- Lines that fade when your face relaxes
- Appointment
- 10 to 20 minutes, no numbing cream
- Downtime
- None. Small bumps for 30 minutes, possible bruise
- First results
- 3 to 7 days
- Sessions
- One, repeated every 3 to 4 months
If you need a little more
Microneedling
From $347
- Best for
- Fine lines that stay when your face is relaxed
- Appointment
- 45 to 60 minutes, numbing included
- Downtime
- Pink for 24 to 48 hours, light flaking by day 3 to 5
- First results
- Hydration and glow within days
- Sessions
- 1 for glow, 3 to 6 for lines and scars
Morpheus8
From $799
- Best for
- Lines at rest with some loosening skin
- Appointment
- 60 to 90 minutes, numbing included
- Downtime
- 2 to 5 days of redness and pinpoint scabs
- First results
- Some tightening in the first few weeks
- Sessions
- 1 to 3, spaced 4 to 8 weeks apart
Prices are starting prices from our menu. Your provider will confirm the plan and total cost at your consult. Individual results vary.
What to expect
What to expect after Botox
You won't see much on the first day or two. The change builds over the first week and settles at two weeks, when we check in with you.
Days 0 to 2
Bumps are gone within the hour, and a pinpoint bruise is possible. Otherwise, no visible change yet.
Days 3 to 7
Lines begin to soften, and frowning takes more effort.
Day 14
Full effect. We check in and touch up anything uneven.
Months 3 to 4
Movement returns gradually. A good time to rebook, before the lines come all the way back.
Timeline for Botox, from our treatment page. Individual results vary.
Our reasoning
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.
What causes wrinkles between the eyebrows?
The 11s between your brows come from the frown muscles pulling the skin together each time you concentrate or squint. At first they fade when you relax. Over time, as collagen thins, they can start to stay, which is when they're best treated early.
Can sunscreen really prevent wrinkles?
It helps more than most people expect. UV exposure breaks down collagen and elastin, so a daily broad-spectrum sunscreen slows the lines that come from sun damage. It won't stop expression lines, which is where toxin comes in.
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From the clinic
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