I can still move my forehead after Botox. Is this normal?

Everyone told me I wouldn't be able to move my forehead muscles once I got Botox. That was actually my biggest fear, but I moved forward with a treatment anyway. Women in all the videos I've seen, who've had Botox, said they their forehead felt frozen. Do you think something went wrong with my Botox treatment?

marystarr

F, 38, New Jersey

Consensus

  • Forehead movement following Botox is normal. The goal of Botox isn’t to completely immobilize movement but to enable a certain amount of it in order to avoid a frozen, unnatural look from occurring.
  • You should begin to experience a decrease in muscle movement one week after your Botox injections and feel the full effect of the treatment within two to three weeks.
  • Your injector may chose to err on the side of caution during your first appointment and inject less Botox than you may desire.
  • During your follow-up appointment two or three weeks later, your provider may perform touch-up injections if you’re still experiencing significant muscle movement.

The consensus is based on 8 doctor replies to this question. For more details, scroll down to read them.


Without more information there's no way to know whether or not you were given enough Botox. It's not clear from your question how many units of Botox were used.

Also, there are many possible Botox injection sites. Some patients have crow's feet. Others have deep horizontal forehead or glabellar lines (frown lines) they hope to correct. Botox can also be injected above the outer area of the brow to create a non-surgical brow lift. Every patient's facial wrinkles are different and the role of an experienced injector is to analyze and understand each patient's unique presentation before beginning treatment. Without knowing anything about your specific cosmetic treatment, I can't give you a direct answer or any specific medical advice.

Generally speaking though, you should see the full effect within two to three weeks after your Botox Cosmetic injections. If you're still seeing some forehead movement and it's been less than two weeks, my advice is to give it a few more days.

Botulinum toxin, the active ingredient in Botox injections, works a little differently in every patient. If this was your first experience with Botox, your injector may have chosen to err on the side of caution. If it's already been three weeks or more since your cosmetic procedure and you're experiencing too much forehead movement, I advise you to contact your doctor or medical professional for a touch-up injection.

Lastly, to clarify something you mentioned in your question: The idea isn't to completely immobilize movement in your forehead. In most cases there should be a limited ability to move your forehead muscles, otherwise the Botox effect can look frozen and unnatural. 

Dr. Alexander Ovchinsky has 1 Botulinum toxin A before & after:

Botulinum toxin A before image performed by Dr. Alexander OvchinskyBotulinum toxin A after image performed by Dr. Alexander Ovchinsky

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Based on your question, it's not possible to give you a specific answer. The full immobilization of your frontalis muscle, procerus muscles, corrugator supercilii muscles, and other facial muscles usually doesn't take effect until around one or two weeks after treatment. Even after two weeks, it's normal to have a small degree of movement in the treated forehead muscles.

We usually ask our patients to return for a follow-up visit around two or three weeks after their Botox injections. During your follow-up, if we find there's still too much muscle movement, we may do touch-up injections. In other cases, we'll make a note and use more units of Botox Cosmetic during your future treatments.

The extent to which Botox works depends on how strong your forehead muscles are. The same amount of Botox can have different effects in different patients. For new patients, experienced injectors will often play it safe and use a slightly lower number of units.

Keep in mind that there's no good way to undo a situation where too much Botox was used. You have probably seen dozens of celebrity photographs where either too many units of Botox were used or injection sites were poorly chosen. In these cases, facial expressions can look frozen and unnatural.

In other cases, Botox can migrate to surrounding muscles with unintended and embarrassing consequences like a drooping upper eyelid.

From your question it sounds like this may be your first Botox treatment. My guess is that your injector may have wisely played it somewhat safe. If it's already been two or three weeks since your Botox treatment, I suggest contacting your doctor and asking about the possibility of a touch up.

It’s not possible to say from your question whether or not something “went wrong” with your Botox treatment. Typically some degree of forehead movement following treatment is a good thing.

It normally takes 1-2 weeks for the full effect of Botox injections to be visible. Typically we ask our new patients to return after 2-3 weeks to assess the effects of their Botox treatment. At that point if there’s too much muscle movement in the forehead, or the frown lines are still too visible, we can adjust our approach. We either add additional Botox, or we can make notes to adjust the quantity and sites of injection for future treatments.

 

Some patients have stronger forehead muscles than others, and other people have deeper than average forehead wrinkles, so the amount of Botox required to achieve the desired effect can vary.

It’s better to be cautious with new patients as too much Botox can result in a frozen look, overly arched eyebrows, or the dreaded drooping upper eyelid.

Always be sure to visit an experienced, board-certified dermatologist or plastic surgeon for the best treatment.

The amount of Botox injected will determine how much movement remains after treatment. To some extent, the amount of movement is a matter of personal preference. When Botox is done correctly there should still be a small amount of movement in the forehead to allow for facial expressions. If there’s a complete “freeze” of the forehead muscles, the effect can look unnatural.

 

The other factor to consider is which specific injection sites were chosen for your treatment. It’s not clear from your question exactly where the Botox was injected. But it’s possible that the injection sites chosen were not sufficient to immobilize the facial muscles effectively — or enough to eliminate your forehead lines.

Remember, it’s easy to add more Botox, and very difficult to correct the effects of too much Botox. So it’s better to start with too little rather than too much.

Botox prevents horizontal lines and other forehead wrinkles by blocking the neurotransmitter acetylcholine in the facial nerves near the injection site. When this important neurotransmitter is blocked, the muscle fibers that control forehead movement stop contracting. It's this temporary paralysis that prevents frown lines and other forehead lines from forming on the forehead.

Botox is extremely popular because it achieves some of the effects of a forehead lift without the need for plastic surgery.

While many new patients often hope to see an instant Botox effect, keep in mind that acetylcholine doesn't just vanish overnight. It typically takes around two weeks for the full effect of Botox to be visible. I can't tell from your question how long ago you received your Botox injections, but if it hasn't been two weeks yet, my advice is to wait.

The extent to which Botox works to prevent forehead movement depends largely on the individual strength of your frontalis, occipitalis muscles, and corrugator muscles. Likewise, the extent to which crow's feet and fine lines around the eyes can be treated depends on the strength of your orbicularis oculi and procerus muscles.

If this is your first Botox treatment, my guess is that your injector may have intentionally used a slightly smaller number of units. Everyone reacts to Botox differently and it's always better to use too little Botox than too much Botox on a new patient. Negative results from injecting too many units of Botox can make for an unpleasant few months.

For the best Botox results, I always recommend that patients consult with an experienced, board-certified plastic surgeon or dermatologist.

It depend how much Botox is used. In my office we customize the Botox treatment. If you feel that you still have a lot of movement go back to the doctor and ask for some additional Botox. You may need some more. The first time a doctor injects your Botox they may not realize just how strong your forehead muscles are. Nothing went wrong with your treatment it just might need a little booster. Also some patients like some movement and don't want a frozen look. It's better to put in less and add since you can't take Botox out. 

Dr. Debra Jaliman has 4 Botulinum toxin A before & afters:

Botulinum toxin A before image performed by Dr. Debra JalimanBotulinum toxin A after image performed by Dr. Debra JalimanBotulinum toxin A before image performed by Dr. Debra JalimanBotulinum toxin A after image performed by Dr. Debra JalimanBotulinum toxin A before image performed by Dr. Debra JalimanBotulinum toxin A after image performed by Dr. Debra JalimanBotulinum toxin A before image performed by Dr. Debra JalimanBotulinum toxin A after image performed by Dr. Debra Jaliman

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Well done Botox should not freeze the forehead, but improve the frown and forehead lines.  It's not unusual that people need more Botox than they initially received, so you should visit your doctor with the question.

It depends how long ago you've had Botox. Sometimes the effect needs up to a week before everything is frozen. I'd address this with the plastic surgeon who injected your brow. Personally, a little preserved movement is a good thing. It depends how much movement you have.