Are you bothered by the wrinkles on your forehead and do not have an action plan about how to get rid of them? Then this blog post is for you.

To understand how forehead aging occurs, we will take a look at the very basic anatomy of the forehead and review the mechanisms of aging. Our goal is not to take you to medical school, but you need a minimal amount of knowledge to properly understand treatment options.

The key points about forehead anatomy are as follows:

Forehead, temple, eyebrows and upper eyelids constitute a whole anatomically. Just as there are imaginary borders that separate states on the map but do not physically exist on the earth, so is the upper part of the face. We say, “This is the eyebrow, this is the temple, this is the forehead, this is the scalp,” but in fact, all of these are a single structure.

On the forehead surface, there is a large muscle that travels from top to bottom like a roller blind: Frontalis. When this muscle contracts, it shortens the forehead, wrinkles it and raises the eyebrows. There are horizontal connections between the frontalis muscle and the skin, and the wrinkles correspond to these connection points.

For now, that's enough to know.

 

 

So how does the forehead age?

When you look at the faces of young people and even children, you will see that the forehead and temple area is full of volume. This fullness gradually decreases over the years. In fact, we lose a large amount of volume in this area, but this volume loss is so slow, so regular and so smooth that we may not perceive the thinning of the soft tissue here, although we see ourselves in the mirror every day.

As the soft tissue between the skin and muscle becomes thinner, the effects of muscle contraction begin to be more pronounced on the surface. Remember that when you remove half of the sponge in a cushion, the tension of the cushion decreases, and it looks saggier. When the forehead and temple area loses volume, it almost deflates, empties and becomes prone to sagging. Gravity pulls the entire anatomical unit down as a whole, and gravity is not alone in doing that. The muscles around the eyes, which are used to pull the eyebrows down, also work together with gravity, accelerating the sagging process. Particularly since people living in sunny places constantly squint their eyes, the muscles that serve to squint work all the time, and forehead/temple/eyebrow drooping is seen at a much earlier age in these people.

When the eyebrows droop, resulting in a buildup of skin on the upper eyelid, this buildup weighs on the very delicate upper eyelid. The strength of the tiny muscles responsible for keeping the eyelid open is not enough to lift the drooping eyebrow mass. When this happens, the weak muscles on our eyelids send a letter to the brain asking for help.

“You know, there was this big muscle like a blind (frontalis) in the forehead. Use it and pull those eyebrows off us,” the eyelids say. The brain means no harm to the eyelids, and it sends instructions to the frontalis muscle. LIFT THOSE EYEBROWS!!! Think of this instruction not as a one-time order, but as a circular that must be followed continuously. The frontalis muscle begins to contract continuously if the eyes are open. As a result, horizontal forehead wrinkles that appear only when we raise our eyebrows become persistent and permanent, deepening all the while.

It is not possible to design the treatment without understanding the mechanism. The treatment of the mechanism I described above is to lift the entire anatomical unit covering the forehead, temple and eyebrows as a whole and replace the volume loss. To do that, we use various forehead lift techniques as well as tissue transfer techniques. I will explain the details of these techniques in future posts, but for now, let's take a break from this basic level of knowledge.

In a specific group of patients, there are many horizontal wrinkles on the forehead that become pronounced at a very early age and without the effects of gravity, although the eyebrows are not drooping and there is no excess tissue on the upper eyelid. In these people, the frontalis muscle may be overdeveloped; the connections between the muscle and the skin may be more frequent and stronger than normal; the soft tissue pad between the muscle and the skin may be congenitally thin; and the eye may have excessive mimic movements because of light sensitivity or behaviorally. If any of these conditions is present, the exaggerated mimic activity can be controlled very successfully with BOTOX injections, and forehead wrinkles can be eliminated to improve the cosmetic appearance.

The problem is the indications of BOTOX treatment in the forehead aging process are limited to the "primary muscle hyperactivity" cases that I mentioned in the paragraph above. Primary muscle hyperactivity is observed in 30-35% of patients presenting with forehead aging, and this group benefits from BOTOX treatment. In the remaining 65% of the patients, there is the forehead/temple/eyebrow drooping that I mentioned previously. These patients do not benefit from BOTOX treatment, and weakening their forehead muscle with toxin increases the drooping of the eyebrows or the speed of drooping of the eyebrows.

In other words, BOTOX is not good for every wrinkle you see on your forehead.

In a group of patients, the process called "surface aging" may be more dominant. Due to problems such as sunlight, smoking, stress and connective tissue diseases, the skin quality deteriorates on the wide surface of the forehead, and the compact adipose tissue layer just below the skin disappears completely. Wrinkles, spots and prominent veins are typical signs of this kind of aging. In this patient group, it is necessary to focus on resurfacing treatment options. Chemical peeling, dermabrasion and nanofat are some of my favorite options I use frequently. I will share detailed information about these processes in my upcoming posts.

Take good care...

... of yourself and your beauty.