Any advise on smoothing forehead lines that extend down to the brow line? Don't want to inject the frontalis too low and drop the brow.

A combination of a monophasic HA filler like Belotero or Juvederm and tiny droplets (half unit) of onabotulinum toxin or incobotulinum toxin injected very superficially in the lower part of the Frontalis (total 1-2 units/side). By injecting superficially, you don't reach the deep fibers of the Frontalis and you don't get a brow ptosis.

Most people create those forehead lines by constantly raising their brows. I always remind my patients to refrain from this activity.

I couldn't agree more with yh. I would suggest that the static lines be filled superficially with HA (Juvederm ultra) then I blend it with xylocaine to reduce hydrophilic effect. Lastly, I use microbotox to fill any dynamic lines. This technique is surprisingly effective with no ptosis.

Mild to moderate forehead lines will usually disappear with 2-4 treatments of Botox. For deeper forehead lines a strong Botox treatment to the full brow and along the hairline of the upper forehead is ideal.

I love using Artefill with a blunt cannula; this combination gives the patient a beautiful long-term and comfortable treatment.

Respectfully seeking your advise colleagues. I have a few male patients with deep forehead lines. I have tried Botox but it seems that it isn't enough. Can you share particular products/ techniques to treat this? Thank you in advance!

For males with stubborn lines I use Botox and follow with 1540 nm fractional resurfacing , usually 3 treatments about a month apart.

Some of our clients have deep lines in their forehead too. Repeated use Botox thrice a year workd well. I always tell them the first treatment will be an improvement but if they come in regularly the results will get better. How about a resurfacer as well? laser/peels? I think filler would make a right mess in the forehead.

I do a few males, but scare them with the real possibility of brow ptosis with aggressive treatment. With patience and time, one gets atrophy of muscle with toxins which helps with appearance

We use more units for males as well as aggressive chemical peels. I have had good results with this formula. The VI peel or use of higher concentration of TCA is a great way to lessen deep lines

Using a filler in the forehead is not recommended. Just use Botox, usualy in a higher dosage than in females, but take care of brow ptosis!

I would definitely use Juvederm Refine. This is the only product I would use here as its important for it to sit superficially in the papillary dermis for it to lift the line but for it not to be seen. This gives a fabulous result along with using high dose Botox.

I still feel that fillers, particularly Botox, can have a role in treating deep lines in males. However, my main concern of high dose Botox is brow ptosis. Can you give me tips on how to avoid this?

I tend to avoid fillers in deep forehead lines as it is difficult to achieve a smooth result. I have seen a colleague use Radiesse which made the patient unhappy with the results. Fine lines are a lot easier especially using a collagen type technique with a less viscous product like Refine. I would agree with those advocating Botox over a prolonged period of time as the lines will eventually get softer. Fractional resurfacing and peels would also help in the right skin types.

It depends on how superficial/deep the crease is. I prefer chemical peels. However, when it's deep, I also perform fat grafting.

I have gotten great results with Botox and Juvederm with a cannula. I also like Belotero, but observe residual redness and product lumps last longer.. although everything dissipates after two to three days

I have often used Restylane Vital for women with low brows or who hate the Idea of Botox. I have never known someone who wants a completely smooth forehead.

If using a filler in the forehead a soft filler is needed, best applied with a cannula, make sure you know the anatomy well and in particular where the major vessels are to avoid these. I have had very good results on deep forehead lines with Vital Light or Re Density, where Botulinum Toxin has not been enough.

I use Botox and Juvederm using a 27 g or 30 g microcannula to do a deeper layer and then follow that with Belotero with traditional technique. I agree that Botox over time can help you achieve an excellent aesthetic result over time -- the way you know this is true is if you have ever had a patient with Bell's palsy or facial paralysis -- over time even the deepest of forehead rhytids are smoothened out when there is little to no movement of the forehead. The vertical rhytids in the glabellar and paraglabellar region that can develop in the older male does generally require some intradermal filler.