A lot of people tell me, “Doctor, I want that really smooth, glossy forehead.” I get it. But I don't think the same result suits every face. Some people naturally rely on their forehead muscles to lift their brows or open their eyes. If we relax those muscles too much, the lines may improve while the eyes end up looking heavier. To me, good Botox is about looking like yourself, not freezing every line.
A smooth forehead isn't the goal for everyone
The forehead muscle helps raise the eyebrows. If your brows or upper eyelids already sit low, you might be using that muscle without noticing. I like to watch someone open their eyes, raise their brows and frown before we talk about how smooth the forehead should become. A little movement left in the forehead is not necessarily a bad result. Sometimes it is exactly what helps keep the eyes looking comfortable and natural.
Why I look at the frown lines as well
The forehead and the muscles between the eyebrows work together. Treating one area without considering the others can change that balance. I prefer to assess both, rather than assume the wrinkle itself tells the whole story. It doesn't mean everybody needs injections in both areas. It means we should understand what each muscle is doing before deciding.
Crow's feet: I still want your smile to look like yours
I don't mind a few lines appearing when someone genuinely smiles. What concerns me more is making the area so still that their smile feels different. The pattern and strength of the muscles around the eyes vary, so there isn't a standard set of points or doses that suits everyone.
Why I don't recommend jaw Botox to everyone
Personally, I am quite selective about reducing the masseter muscles. They do influence how square the lower face looks, but reducing their bulk can also change the support and proportions of a face that already has some sagging. I become especially careful as patients get older. Age alone isn't a rule that says someone can or cannot have treatment; it's one part of the overall assessment.
For jawline lifting, I also look at the neck
When someone asks for a sharper jawline, I consider the platysma, a muscle extending across the lower face and neck. Depending on the person, it can be relevant to a treatment plan. But fat, skin laxity and underlying facial structure are different problems. Botox cannot fix all of them.
What about the days after treatment?
Small injection marks and bruising can happen. I pay attention to careful technique and how we look after the area immediately afterwards. Some people notice changes within several days, but the time to judge the result depends on the treatment area and the product used. New significant drooping, unusual weakness or difficulty swallowing or breathing needs prompt medical attention; severe symptoms need emergency care.
Two patients, one request: “Make my forehead smooth”
Imagine one person whose brows sit comfortably and another who constantly raises their forehead just to keep their eyes open. Giving them identical treatments wouldn't make sense to me. They might both leave with fewer lines, but they wouldn't necessarily feel equally happy with their eyes. This is why I assess a face in motion, not just one still photograph.
Questions I hear a lot
Can forehead Botox make my eyes feel heavy?
It can, particularly when the forehead muscles were helping support the eyebrows beforehand. That's one reason I assess the eye and brow area first.
How many units do I need?
There is no magic number. The product, muscle activity, treatment area and individual goals all matter. Please don't use a friend's dose as your own plan.