This is a discussion of wrinkles, how to treat them and the different alternatives out there. To make things more relevant we are going to concentrate on the wrinkles on the forehead to give you some perspective. But, in general, these treatment principles can be applied to anything on the face.
Wrinkles in the forehead are never attractive. They make you look worried, stressed, and aged, etc. There are many different options to rejuvenating the forehead. Included among these different approaches are Botox, brow lifts, chemical peels, facial implants, fat injections, fillers, laser resurfacing, brow muscle modification.
Botox is a very common approach to improve the wrinkles in the forehead area. Botox is a neuromuscular agent that works on the nerves that innervate the muscles and prevent the movement of the muscles. With less muscle movement, your wrinkles are not constantly getting deepened. Over time with continual use, you can decrease the wrinkles that have been etched as well, but this must be maintained. Botox is not a permanent solution. Typically, Botox lasts for about 3 – 4 months. So this is something to consider.
As we mentioned above, Botox can help your wrinkles. Specifically, the wrinkles that are improved are the dynamic wrinkles. By dynamic, we mean the wrinkles that are caused by movement. Botox can also help static wrinkles. The wrinkles that are present when you don’t move your facial muscles. But the way to do this is to be on Botox on a regular basis. Through the constant relaxation of your facial muscles, the skin is allowed to regenerate over time. The Botox relaxes the muscles allows the skin to take a break from the constant forces of the muscle movement and the persistent forces on the wrinkles. Because you have skin cells that are constantly remodeling the skin, these skin cells are allowed to remodel the skin without external influences. So previous wrinkles are often reconstructed by these remodeling skin cells and the wrinkles become more erased because of this action without facial muscular influences due to the influences of Botox.
Brow lifts are another way to improve forehead wrinkles. Often times, as a person ages and experiences drooping of the eyebrows, a compensatory maneuver is for the person to elevate the eyebrows to improve their vision. This constant action to lift the eyebrows also causes more wrinkles. Brow lifts serve to reverse this by elevating the eyebrows so that this muscle action and movement is reduced. This prevents some of the wrinkles from being formed. Also, through a brow lift, your surgeon can alter your muscles in the brow so that you will have less movement by some of the muscles that are causing deep wrinkles. The most common area for muscle modification is in the area in between the eyebrows. You can have these muscles reduced so that you have less ability to furrow your brows and create the “11” wrinkles (commonly referred wrinkle).
Chemical peels and laser resurfacing with the CO2 laser are also options for improving wrinkles in the forehead by causing contraction of the skin and reducing the absolute amount of skin in the forehead. The most that has been found to be reduced is about 1/2 to 1cm of skin reduction in the forehead. This, however, might be an exaggeration and is likely more on the level of 1/4cm to 1/2 cm. The way that these moderate and deep resurfacing techniques can improve wrinkles in the forehead is through creating a layer of tissue just under the skin that is responsible for the wrinkle reduction and skin tightening. The other benefits of resurfacing, with either chemical peels or co2 laser resurfacing, are improvement of pigment disorders and skin texture.
What else causes wrinkles in the forehead? A volume loss is one of the main contributors. Volume loss in the forehead allows the skin to come to a closer proximity to your muscles and it allows the muscles to exert more influence on the skin and hence create more wrinkles. Much of the volume loss is from tissue being degraded and reduced over time by the body. From the stand point of wrinkles, the volume loss between the skin and muscles of the face play the biggest part in the development of wrinkles. Again, with the closer proximity of the skin this extra volume can prevent the influence of the facial muscles on the skin. The effects of volumizing has immediate and long term effects. As soon as you volumize the face, the skin will look better. The easy way to imagine this is with a balloon. Notice how when you plump / or pump up the balloon, the more air you put in, the more stretched the balloon becomes. As the balloon stretches, the balloon’s rubber covering becomes more stretched. What you often notice is that the balloon appears shinier the more air that is being inflated.
Hence, what you are seeing more and more these days, cosmetic surgeons are using more filler and volumizing approaches to the forehead. Fillers are one way to improve wrinkles by volumizing the space underneath the wrinkles, thereby improving wrinkles in the manner that was described in the previous paragraph. Fillers, however, can be quite expensive. Fillers only fill in small amounts of volume. The situation often requires a more global filling effect to achieve a general rejuvenation of the face. When on ages, they tend to lose a significant amount of volume all over the face. The total amount of volume lost can be in the range of 30-100cc. Fillers typically come in 1cc syringes. When you use fillers you are essentially carrying out camouflage techniques for the most part. Fillers bring volume to only small areas of the face. Sometimes for a more natural look, one requires more overall filling to accomplish overall rejuvenation of the face. Fillers are also more temporary in nature with their results being measured in the 6 months to one year range. So the desire for better and more longer lasting results are being looked into continually.
More and more studies and news reports are focusing on this global volumization of the face for facial rejuvenation. One approach is through facial implants. Cheek and chin implants are the most common. Forehead implants however aren’t common. In face they are rare. Lateral Jaw implants are being done but aren’t as common as cheek and chin implants. Temple implants are done rarely but more than forehead implants. The advantage of facial implants are there permanence. They won’t get absorbed and won’t go away. The volume that you get will stay. The drawbacks are the significant surgical approach that will be needed. They have the risk of getting infected. Also the shapes are dictated more with the implant and less on sculpting, although you can shape the implants by carving them there are some limitations.
This global volumization has led to a comeback for fat grafting in the face. Although this technique has been around for decades, it has now been brought back and is as popular as ever. This approach follows this idea of volumizing and replacing lost tissue rather than taking away tissue. With this approach, we are trying to bring back the volume of the raisin back to a grape, the more youthful and natural looking grape. We are trying to avoid the pulled raisin look that traditional procedures have done in the past. The benefits of fat grafting are that they are associated usually with way less discomfort. Fat grafting can be done without facial incisions, general anesthesia, and drains.