Botox for forehead wrinkles gains FDA approval

An open secret for several years is that use of Botox for the forehead was “off-label,” meaning that although it was common practice, it was not specifically approved by the FDA for that purpose – until now. This now makes 3 areas on the face – the vertical lines between the eyebrows and crow’s feet being the first two – that are approved uses. But treating the forehead requires a higher level of judgment and skill to achieve the desired results without adverse effects.


Botox, the most popular version of botulinum toxin type A, works by relaxing hyperactive muscles. In the face, these are muscles of expression, such as the “corrugator” muscle that pulls the skin into vertical furrows between the eyebrows. That is why the injections are placed into the muscle and not the wrinkle, as with fillers. Relax the muscle, the furrows soften.

Why treating the forehead requires special skill

In the forehead, it is important to understand why the muscle is hyperactive. The target muscle is called the frontalis, whose function is to elevate the eyebrows. The result of a hyperactive frontalis is horizontal lines. With the corrugator muscle, hyperactivity is usually the result of habit or stress, but in the forehead it may have other causes. Often this is a sagging of the eyebrows, so the muscle compensates. In that situation, relaxing the frontalis muscle with Botox will reveal the droopy brow. The wrinkles will go away but the price is a tired look – the opposite of what you want! This is where the judgment and skill of the injector becomes important.

Experience counts with Botox to the forehead

With nearly 25 years of experience using Botox, I have seen it come from an obscure product when all cosmetic uses were off-label, to one of the most popular treatments. There are around 7 million Botox injections every year, a testament to its effectiveness and safety. There are multiple indications for it now, ranging from prevention of migraines, bladder spasms, and excess sweating to wrinkle reduction. One thing has stayed the same: the best results come from experienced injectors.

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