What can I really do about…my Forehead?

This is a tough one. Because the forehead has become a battleground of sorts. It's the easiest place to tell if you've had work done — look at any newscaster, male or female — if their forehead is smooth and unmoving, they've had something done.

But it's a sensitive area due to being a focus of criticism, which can be pretty hypocritical at times. Nevertheless, it's also arguably one of the easiest areas to fix.

Creams and general attention to hydration to the skin will always help. But when the lines have gotten deep, so that the trace of them is still there when you pull the skin, or the eyelids droop down significantly — that's when people begin to think they want to do something. 

Most often it's the "railroad tracks" (glabellar creases) between the brows that are the trigger. My friend Sari said people just thought she was angry all the time.

There are a number of brow lifts available, explains Yael Halaas, M.D., FACS, a NYC facial plastic surgeon. The Gold Standard, she says, is the endoscopic browlift — a technological innovation allowing for a series of small incisions behind the hairline to lift the forehead and eyelids, but leaving the hairline as is.

A pretrichial browlift goes along the hairline and can require bangs to cover the area afterward. Dr. Halaas says this is less common nowadays but a good choice for people with high foreheads.

A coronal lift is back by the ears or with a surgical type of headband effect, which can raise the browline but also gets rid of the droopy eyelid effect, as do the direct browlift procedures.

A lateral browlift is also an option that allows the surgeon to go in though the eyelids. The benefit of this is using the same incision as an upper blepharoplasty, which removes excess upper eyelid skin.

All of these can range from $5000– $10,000, with a general healing time of about a week to 10 days.

Perhaps you remember the scene in It's Complicated, where Meryl Streep runs out of her consultation, frightened by the stated side effects of a brow lift? Dr. Halaas says the side effect can include forehead numbness, dryness of the eye (rarely, she notes), hairloss at the site of the small incisions or a surprised, too elevated look.

She recommends that people considering this procedure opt for earlier rather than later, "so you can enjoy it longer." To wit, my friend Abby marvels at a colleague of hers who had it done in her mid 40s, "and she still looks great more than 10 years later!"

Two recent studies lead by facial plastic surgeon Steven Dayan, MD, FACS, one published in Dermatologic Surgery, indicated that Botox not only smoothes fine lines and wrinkles, it smoothes aspects for your life as well. The findings suggested that people with Botox make a better first impression, are perceived as more attractive, even more athletic. (Wha…?)

The supposition: Botox makes one look friendlier and improves confidence. In one study, when a control group of Botox-treated individuals were surveyed vs. a group with salt-water injections, the Botoxed individuals rated themselves as happier. Sadly, they also report blue moods once the solution wore off.

Even though Botox only got FDA approval in 2002, it's been in use for longer. And like any new toy, it was overused for a while — freezing faces to the point of immobility, and getting a bad rap for that. But a tool can be only as good as the person using it, so your doctor's application counts for a lot.

Furthermore, finesse has been learned since then — doctors often modulate the use of how much and where, so a little movement here and there is possible. Dr. Halaas notes the use of super-fine insulin needles for targeted application (not to mention less discomfort). And you should discuss with your doctor how frozen you want to be and how much of an arch in your eyebrow — this option also allows for a lift.

Dysport is new on the scene and gaining in popularity because it purportedly works faster and lasts longer.

In authentic guinea pig fashion, I tested a peculiar version of the Dysport challenge: half forehead Botox, the other Dysport. True to reports, the Dyport took hold in about 2 days, whereas the Botox took about 4 or more. Which made for a bit of cockeyed look at first — don't try this at home.

But what difference does it make? Dr. Halaas pointed out that for an imminent job interview, party or important function, it matters to some patients. Plus, since Dysport is supposed to last longer than Botox, I may look off-kilter at the other end as well… we'll see.

Another aspect I didn't know — you can do crows feet too, and that actually gives a little lift to undereye crêpeyness as well.

Depending on how many injections/syringes you require, this can run from $300–$800 and last 3 to 8 months or longer depending on age, stress and home maintenance.

Thermage and Fraxel are other non-invasive options but they are not isolated to the brow and so will be covered in a subsequent article. 

Topical solutions are obviously less expensive. Although I wonder… if you go for a high-end cream, and buy that, or a bunch of them over and over — it adds up.

There are a number of creams that purport to take the place of Botox and the like by freezing the muscles naturally. Freeze 24/7 is just one of them ($65-$150 for a kit). In fact, Barbara Grufferman discusses this in her book, The Best of Everything After 50. 

She consulted dermatologist Dr. Patricia Wexler who recommended products that contain a GABA peptide, which works to relax the underlying muscles. She also recommended her own Fastscription Advanced No-Injection Wrinkle Smoother ($29.50) — easily available at Bath & Body Works. 

Another option: Frownies ($19.95), and similar facial patches to put over lines to help smooth them out. I remember my mom doing this back in the '70s. Personally I wish there was an iron to just press them out. 

Grufferman also notes that these methods may help prolong the effect of the injectables. These are short-term, temporary fixes, but it may be all you need or want. And there's always bangs.