Customising Forehead Treatment to Your Muscle Pattern

A 2020 paper by a Brazilian dermatologist proposed a structured way to plan forehead wrinkle-relaxing injections based on each person's muscle shape and strength, rather than using the same pattern for everyone. It is an expert-opinion paper illustrated with a single patient, so it describes an approach rather than proving it works better. Still, its central idea, that foreheads differ and treatment should reflect that, is a useful one for patients to understand.

Why this was studied

The frontalis is the muscle that raises the eyebrows and creates horizontal forehead lines. It is also the only muscle that lifts the brows. Relaxing it too much, or in the wrong places, can leave the brows feeling heavy or lowered, or create an unwanted arched or "surprised" look.

Earlier anatomical research had described several frontalis patterns. Some people have one broad sheet of muscle across the whole forehead; others have two bands with a gap in the middle, a mainly central muscle, or two bands set far to the sides. The author wanted to turn that knowledge into a practical planning method so that injection points and amounts match the muscle that is actually there.

What the researchers did

The paper describes a three-step method. First, the injector assesses the forehead using a grid of reference lines based on landmarks around the eyes and the top of the forehead, giving a set of possible injection points. A key element is a safety line low on the forehead: the author advises keeping doses at or below it small, and not injecting beneath it, to protect brow position.

Second, the patient's goals are discussed, including how much movement they want to keep and whether they want the brow shape to change. Third, the injector presses gently on each area while the patient raises their brows, judges the muscle strength there and adjusts the amount accordingly, using more where the muscle is strong and little or none where it is weak or absent.

The paper also explains how the position of injections relative to the pupil can influence brow shape, and stresses treating the muscles that pull the brows down at the same time, for balance.

What they found

The method was illustrated with one woman in her mid-thirties who had forehead lines, uneven brows and a previous experience of feeling "frozen" after treatment. After a customised plan, her lines on raising the brows were reported to have improved at 15 days, and the lower outer part of one brow sat a little higher, giving a softer arch. No brow drooping or other side effects were reported in her case.

How strong is this evidence?

This is expert opinion with a single illustrative case. There was no group of patients, no comparison with standard injection patterns, no statistical analysis, and follow-up shown was short. Muscle strength was judged by touch, which is subjective. The paper also reports a small inconsistency in how the at-rest result was scored.

The author had consulting ties to the maker of the product used, and the company supported medical writing. The paper also suggested its dosing might not transfer to other botulinum toxin type A products, which has not been tested.

So the paper cannot show that this specific method gives better or safer results. What it offers is a clear framework for something many experienced injectors already aim to do: individualise treatment.

What it means for you

If you have had forehead treatment that left your brows feeling heavy, or a look you did not like, that does not necessarily mean the treatment is wrong for you. Different muscle patterns and goals may call for a different plan. Our article on treating forehead lines covers the basics, and neuromodulator dosing explained describes why amounts vary.

At a consultation, expect your injector to watch your forehead move, look at your brow position at rest and when raised, and ask what you want to keep. Some people with low-set or heavy brows, or hooded upper lids, may be advised to have only light forehead treatment, or none, because the frontalis may be helping to hold their brows up. Our article on brow or eyelid heaviness after treatment explains this.

Common side effects of botulinum toxin type A include small bruises, mild headache and temporary heaviness. Uncommon effects include brow or eyelid drooping, which usually fades over weeks. Treatment is not recommended during pregnancy or breastfeeding, with active infection at the site, or with certain neuromuscular conditions, and some medications need discussion. Results typically appear within 3 to 14 days and last around three to four months, varying from person to person.

Questions to ask at your consultation

• What does my forehead muscle pattern look like, and how does that shape your plan?
• How much movement will I keep?
• Is there a risk of my brows feeling heavy, given my brow and eyelid position?
• Will you treat the muscles between my brows as well, and why?
• When should I come back to assess the result?

Frequently asked questions

Can I tell my muscle pattern by looking in the mirror?

Partly. The paper notes that the shape of your lines, for example whether they run fully across or break in the middle, can hint at the pattern. A clinician watching you move and feeling the muscle gives a better picture.

Does a customised plan mean a bigger dose?

Not necessarily. Tailoring often means less in some places and more in others. The aim is balance, not maximum effect.

Why was treatment between the brows part of the plan?

The muscles between and around the brows pull them down, while the frontalis pulls them up. Treating only one side of that balance can change brow position in ways people may not want.

If you would like your forehead assessed and a plan explained in plain terms, HealthPark Medical Aesthetics can walk you through your options, including whether light treatment or none may suit you best.

Source

de Sanctis Pecora C. One21: a novel, customizable injection protocol for treatment of the forehead with botulinum toxin type A. Clinical, Cosmetic and Investigational Dermatology, 2020. Read the study