What is forehead botulinum toxin?
Forehead botulinum toxin is a procedure directed at the appearance of the horizontal lines across the forehead. Whether any change in appearance is possible is assessed at the examination.
The substance used in this procedure, which is popularly known by a brand name, is botulinum toxin. Botulinum toxin is a prescription-only medicinal product for human use (opens in a new tab) that temporarily reduces the contraction of the muscle into which it is administered. The procedure is carried out with an authorised product, within the terms of use in its authorisation, and by a physician.
The function of the forehead muscle is to hold the eyebrows up. When the contraction of this muscle is reduced, the eyebrows may come down. For this reason, forehead botulinum toxin is not planned without assessing eyebrow position, and the forehead is not addressed on its own, independently of the area between the eyebrows.
This area is part of the 3-Area Botulinum Toxin assessment.
The procedure is performed at the practice (opens in a new tab) by Dr. Suzan Alp, Specialist in Internal Medicine.
Which factors determine whether the procedure is suitable?
The decision on suitability is made at the end of the examination. The decisive factors in the assessment of this area are:
- Eyebrow position and eyebrow height
- Whether there is laxity or excess skin in the eyelid
- The height of the forehead and the strength of the forehead muscle
- Whether the lines appear with movement or also remain when the face is at rest
- Whether there is a marked habit of raising the eyebrows
In those who habitually hold their eyebrows raised, this procedure may change eyebrow position noticeably; this possibility is discussed before the procedure.
In which patients is the procedure not performed?
- In patients with a disease affecting the neuromuscular junction (myasthenia gravis, Lambert-Eaton syndrome, amyotrophic lateral sclerosis and similar conditions)
- In pregnant and breastfeeding patients
- In patients under 18 years of age
- In patients with a history of allergy to the product to be used or to its components
- In patients with an infection, an open wound or an active skin disease at the site of the procedure
Situations that require separate assessment
- Muscle disease (an assessment by the relevant specialist physician is required)
- Use of medicines that affect neuromuscular transmission (aminoglycoside antibiotics, muscle relaxants and similar)
- Bleeding or clotting disorder, or use of blood-thinning or anticoagulant medicines
- Active infection or febrile illness (the procedure is postponed)
- A recent procedure in the same area (the timing is adjusted accordingly)
Additional conditions specific to this area
In these situations, the procedure is planned subject to the physician’s assessment:
- Eyebrow drooping (the procedure may make it more pronounced)
- Eyelid drooping
- Marked excess skin on the upper eyelid (if the eyebrows come down, the field of vision may be affected; an assessment by the relevant specialty may be required)
- A field of vision kept open by raising the eyebrows
- A short forehead, or markedly different muscle strength in the forehead (the planning changes accordingly)
How is the procedure performed?
- Assessment. Eyebrow position, eyebrow height and the condition of the eyelid are assessed; the strength of the forehead muscle and the type of lines are determined. The physician asks about any history of neuromuscular disease, current medication, allergies and previous procedures. Blood pressure and pulse are measured.
- Product check. The authorisation status of the product to be used, and its compliance with storage conditions, are checked.
- Information and consent. The procedure, the fact that the effect is temporary, the possibility of eyebrow drooping and of a feeling of heaviness in the forehead, and possible side effects are explained in writing and verbally; a form is signed.
- Preparation. There must be no make-up on the area. Antisepsis is ensured.
- Administration. The product is administered at the determined points with a fine needle.
- Observation and follow-up. Vital signs and anything observed are recorded in the file. A follow-up appointment is arranged, at which the outcome will be assessed.
When does the effect begin, and how long does it last?
The time it takes for the effect to appear varies from person to person; the full result is assessed between a few days and two weeks. The effect is temporary, and how long it will last cannot be stated in advance. The timing of any repeat is determined at the follow-up.
What should you do before and after the procedure?
Before the procedure, report:
- A list of all the medicines and supplements you use (in particular blood thinners, painkillers and antibiotics)
- Your known allergies
- Any history of nerve or muscle disease
- Your pregnancy and breastfeeding status
If you feel that your eyelid is drooping or that your field of vision is narrowing, please say so.
Come with no make-up on the area.
After:
- The area must not be massaged or rubbed on the day of the procedure
- You are asked to avoid bending forward, keeping the head down for long periods and lying face down for the period specified
- Avoid hot environments, saunas, sunbeds and intense exercise for a period
- Temporary raised bumps, redness and slight bruising may occur at the points of administration
- A temporary feeling of heaviness or tightness may occur in the forehead
Recommendations specific to you, and the time periods involved, are given in writing at the end of the procedure.
Risks and side effects
Risks specific to this area
- Eyebrow drooping (an unwanted outcome frequently reported in forehead botulinum toxin)
- A change in eyebrow position, and eyebrow asymmetry
- A feeling of heaviness, tightness or pressure in the forehead
- A greater lift than expected at the outer part of the eyebrows
- Differing amounts of residual movement in the upper and lower parts of the forehead
General risks that may occur with any minor procedure
- Pain, redness, swelling and bruising
- Infection at the site of the procedure
- Headache
- Eyelid drooping
- A change in facial expression; a greater reduction in facial movement than expected
- Allergic reaction
- Flu-like symptoms
- Vasovagal syncope (fainting)
These side effects are temporary; however, the time they take to resolve varies from person to person and may last weeks. It is not possible to reverse the effect of the botulinum toxin.
Results vary from person to person.
When should you see a physician without delay?
If you experience these symptoms during treatment, contact your physician without delay:
- Drooping of the eyelid, or a change in vision
- Increasing redness, increased warmth, swelling or discharge at the site of the procedure
- A high fever
- Widespread rash, itching
In the event of difficulty swallowing, disturbance of speech, double vision, shortness of breath, widespread muscle weakness, or swelling of the lips or eyelids, go directly to the emergency department.
Frequently asked questions
Will forehead botulinum toxin make my eyebrows drop?
Eyebrow drooping is the most frequently reported unwanted outcome in this area. The function of the forehead muscle is to hold the eyebrows up; when its contraction is reduced, the eyebrows may come down. For this reason, eyebrow position and the condition of the eyelid are assessed before the procedure.
Can I have botulinum toxin on my forehead only?
The forehead is not addressed independently of the area between the eyebrows. The muscles of these two areas balance one another; performing the procedure on the forehead alone may lead to an unwanted change in eyebrow position. Which areas the procedure is performed on, and to what extent, is determined at the examination.
Will my forehead feel heavy?
A temporary feeling of heaviness, tightness or pressure in the forehead is among the reported side effects. The time it takes to resolve varies from person to person.
I raise my eyebrows to see; can I still have the procedure?
In those who raise their eyebrows to keep their field of vision open, and in those with marked excess skin on the upper eyelid, the procedure is assessed separately; if the eyebrows come down, the field of vision may be affected. Please mention this at the consultation.
My forehead lines remain when my face is at rest; will botulinum toxin be enough?
Lines that appear only with facial movement and lines that remain when the face is at rest are not assessed in the same way. In the latter case, the contribution expected from this procedure is limited; which of the two applies is determined at the examination.
How long does the effect of forehead botulinum toxin last?
The effect is temporary and its duration cannot be stated in advance. It varies with the individual, muscle strength and the pattern of procedures. The timing of any repeat is determined at the follow-up consultation.
Is forehead botulinum toxin carried out during pregnancy?
No. The procedure is not carried out during pregnancy or breastfeeding.
Sources
- Ministry of Health of the Republic of Türkiye, Turkish Medicines and Medical Devices Agency, Beşeri Tıbbi Ürünler Ruhsatlandırma Yönetmeliği, Official Gazette 11 December 2021 / 31686. https://www.resmigazete.gov.tr/eskiler/2021/12/20211211-5.htm (opens in a new tab)
- Ministry of Health of the Republic of Türkiye, Ayakta Teşhis ve Tedavi Yapılan Özel Sağlık Kuruluşları Hakkında Yönetmelikte Değişiklik Yapılmasına Dair Yönetmelik, Official Gazette 7 January 2025 / 32775. https://www.resmigazete.gov.tr/eskiler/2025/01/20250107-3.htm (opens in a new tab)
