If Botox Works, Why Have a Forehead Lift?

“I have wrinkles on my forehead. Can’t I just get Botox?”

“Glabellar wrinkles can also be improved with Botox, so is it really necessary to go as far as having a forehead lift?”

These are questions I often hear during consultations for forehead lifts.

In fact, if you only have glabellar or forehead wrinkles, Botox is a good treatment option.

However, the situation is somewhat different when the eyelids and eyebrows have sagged, and wrinkles have developed because the forehead muscles are being overused as a result.

This is because glabellar Botox, forehead Botox, and a forehead lift can all improve wrinkles, but they work in different ways.

• First, let’s look at the muscles of the forehead and glabella. -

Facial expressions in the forehead and glabella are created through the interaction of several muscles.

Muscle	English name	Main function	Wrinkles that mainly appear
Frontalis or forehead muscle	Frontalis	Raises the eyebrows	Horizontal forehead wrinkles
Corrugator or brow furrow muscle	Corrugator supercilii	Pulls the inner eyebrows downward and inward	Vertical glabellar wrinkles, “川”-shaped wrinkles
Procerus or glabellar muscle	Procerus	Pulls the glabella downward	Horizontal glabellar wrinkles
Depressor or brow depressor muscle	Depressor supercilii	Pulls the inner eyebrows downward	Contributes to glabellar wrinkles

As the movements of these muscles are repeated, the forehead and glabellar wrinkles we commonly see are formed.

Muscles of the forehead and glabella: frontalis, corrugator, orbicularis oculi, depressor supercilii, and procerus. Muscles involved in endoscopic forehead lifting. Glabellar muscles. This is a partial-face model who consented to publication.

① Glabellar Botox weakens the glabellar muscles.

The characteristic wrinkles that develop in people who frequently frown are the vertical, “川”-shaped glabellar wrinkles.

Glabellar Botox is used in this situation.

By weakening the contraction of muscles such as the corrugator and procerus with Botox,

frowning movements decrease and the wrinkles are softened.

Therefore, if glabellar wrinkles are the primary concern and eyebrow or eyelid sagging is not severe, glabellar Botox alone can produce a sufficiently good result.

② Forehead Botox is somewhat different.

Horizontal forehead wrinkles are mainly caused by repeated contraction of the frontalis muscle.

Therefore, when Botox is injected into the forehead, forehead wrinkles are softened as movement of the frontalis decreases.

However, there is an important issue here.

The frontalis does not merely create forehead wrinkles; it also plays a role in lifting the eyebrows and eyelids.

People with drooping eyelids unconsciously use the frontalis to raise their eyebrows in an effort to open their eyes.

Drooping eyelids

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Compensatory action of the frontalis to open the eyes

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Continuous contraction of the forehead muscles

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Development of forehead wrinkles

This process can occur.

For people in this situation, forehead Botox may improve forehead wrinkles,

but weakening the frontalis can cause the eyebrows to descend and the eyelids to feel heavier.

Therefore, forehead Botox should be approached cautiously in people with drooping eyelids.

• So what is different about a forehead lift? -

A forehead lift is not a treatment that simply eliminates wrinkles by weakening the forehead muscles.

It is a surgery that lifts the sagging forehead and eyebrows upward and adjusts the glabellar muscles as needed.

For people with drooping eyelids or eyebrows, improving the position of the eyebrows and forehead through a forehead lift may also reduce the compensatory action of the frontalis that has been overused to open the eyes.

In other words, forehead Botox weakens the frontalis,

whereas a forehead lift improves the situation that required the frontalis to be overused in the first place.

• A forehead lift also takes the glabellar muscles into consideration. -

During an endoscopic forehead lift, the surgeon not only lifts the forehead upward but can also directly examine the muscles in the glabellar area and adjust them appropriately when necessary.

In particular, the corrugator (Corrugator), depressor supercilii (Depressor supercilii), and procerus (Procerus)

play important roles in creating glabellar wrinkles and a stern appearance.

Therefore, appropriately adjusting the glabellar muscles under endoscopic visualization can soften vertical and horizontal glabellar wrinkles,

while also making eyebrow movement and position appear more natural.

• Glabellar Botox vs. forehead Botox vs. endoscopic forehead lift -

	Glabellar Botox	Forehead Botox	Endoscopic forehead lift
Main target	Glabellar wrinkles	Horizontal forehead wrinkles	Sagging eyebrows and forehead + wrinkles
Main action	Reduces contraction of the glabellar muscles	Reduces contraction of the frontalis	Lifts the forehead and eyebrows + adjusts the glabellar muscles
Eyebrow sagging	Does not improve it	May cause the eyebrows to descend further	May improve it
Eyelid sagging	Does not improve it	Sagging may become more noticeable	May help improve it
Compensatory action of the forehead muscles	Remains unchanged	Decreases	Improves the cause of the compensatory action
Glabellar wrinkles	Softened	Limited effect	Softened through muscle adjustment
Forehead wrinkles	Limited effect	Softened	Softened through lifting and changes in muscle activity

• Ultimately, what matters is not just the “wrinkles,” but “why they developed.” -

If glabellar wrinkles are your concern, glabellar Botox may be a good choice.

If you only have forehead wrinkles and no sagging of the eyelids or eyebrows, forehead Botox can also be an effective option.

However, if you have drooping eyelids and eyebrows,

and your forehead and glabellar wrinkles have worsened because you continue to use the forehead muscles as a result,

it can be difficult to solve the problem simply by weakening the muscles.

This case involved a woman in her 60s.

Before surgery, she had deep forehead and glabellar wrinkles along with drooping eyelids and eyebrows.

Because she continuously used her forehead muscles to open her eyes, the wrinkles and uneven contours of her forehead were also pronounced.

Before and after endoscopic forehead lifting. Endoscopic forehead lift results. Forehead wrinkle removal. Glabellar wrinkle removal. This is a partial-face model who consented to publication.

Before and after forehead lifting. Forehead lift results. Forehead lift recovery process. Forehead lift recovery period. This is a partial-face model who consented to publication.

In this case, an endoscopic forehead lift was performed, the glabellar muscles were adjusted as needed,

and the sagging eyebrows and eyelids were lifted at the same time.

After surgery, the forehead and glabellar wrinkles were softened, and the forehead skin became noticeably smoother.

Most importantly, as the drooping eyebrows and eyelids improved,

she no longer had to strain her forehead as much to open her eyes. Her eyes felt much more comfortable, and her overall appearance became brighter and softer.

This does not mean that Botox is an unnecessary treatment.

However, if you also have sagging eyelids and eyebrows,

there are cases in which a forehead lift, which lifts the eyebrows and forehead together, may be more suitable than treating the wrinkles alone.

Botox is a treatment that reduces the movement of the muscles that create wrinkles,

whereas a forehead lift is a surgery that lifts sagging eyebrows and the forehead while also adjusting the action of the muscles contributing to the wrinkles.

Therefore, in response to the question, “If Botox works, why have a forehead lift?”

if you only have wrinkles, Botox may be sufficient.

However, if you are overusing your forehead muscles because of drooping eyelids and eyebrows,

a forehead lift may be necessary to improve the underlying cause as well.

That is how I would answer.

Glabellar wrinkle removal. Forehead wrinkle removal. Forehead lift results. Endoscopic forehead lift results. This is a partial-face model who consented to publication.