Causes, Prevention, and Treatment
F orehead Creases or Forehead Rhytids are very common in most people as we age; they are inevitable. Despite being that common, most people do not know how to deal with or get rid of them. They look in the mirror every morning and try to cover up them to look younger, but all the styling techniques fail usually fail to hide them.
Many reasons contribute to the development of Forehead Rhytids such as aging, exposure to the sun, hormonal changes, and chronic stress. On the other hand, there are many ways to get rid of forehead wrinkles. Following certain skincare tips and preventive measures can provide you with a smooth forehead that is free of creases. In addition, many treatments are available to give you a wrinkle-free forehead.
Figure 1 – Computer generated woman with horizontal forehead rhytids (the most common type).
Why Do Forehead Creases Affect Facial Aesthetic?
As we age, our skin starts to lose its elasticity, our muscles’ support starts to decrease, and our soft tissues start to change. Forehead creases develop because of the action of the frontalis muscle, which contracts while raising the eyebrows. The lines across our forehead increase over time, especially in people who are more expressive and use their eyebrows a lot. Most people with forehead wrinkles believe that they look unattractive and older feel stressed. In conclusion, forehead creases are an indicator of age and stress. (1)
What Causes Forehead Creases?
Many conditions contribute to the formation of forehead wrinkles. For example, some people are more stressful than others and maybe genetically predisposed to the development of wrinkles. The causes of forehead creases include
Hormonal aging in women occurs after the menopause. The production of estrogen in postmenopausal women deteriorates dramatically, which leads to deterioration in the strength of elastin and decreases the production of collagen. Eventually, the skin loses its firmness and wrinkles worsen. (2, 3)
Aging is a natural process resulting in breaking collagen down and weakening elastin throughout life. The less and weaker collagen and elastin become, the more wrinkles you will have, including forehead wrinkles. (4)
The sun and its Ultraviolent rays accelerate the aging process and enhance the appearance of aging signs significantly. It exposes your body to more free radicals, which cause inflammations and damages your skin, and inhibit the production of elastin and collagen. The sun is considered a main contributing factor to the appearance of forehead creases. (5, 6)
Chronic stress leads to premature wrinkles, especially forehead wrinkles if you are an expressive person. Being stressed for a long time increases the production of Cortisol, the stress hormone. Cortisol breaks down collagen and inhibits its production. It does not only accelerate the aging process but also prevents your body from rebuilding itself. (7)
Repetitive Facial Movements
Repetitive facial movements contribute to the development of forehead wrinkles over time. You wrinkle your forehead more than you think while frowning, thinking, and expressing your feelings. Over time, your skin finds it hard to get back in its normal place and the temporary lines become permanent. (8, 9)
How To Prevent Forehead Creases?
Aging is inevitable. However, you could have a healthy, smooth, wrinkle-free forehead for as long as possible if you followed a good skincare routine and chose a healthy lifestyle.
Use a high-quality Sun Protection Factor (SPF), especially on the days that you must be exposed to the sun for a long time. SPF should be of at least 15 to be effective. (10)
Reducing your stress level prevents the formation of forehead wrinkles significantly. Your cortisol levels will be reduced, which enhances collagen and elastin production. In addition, your repetitive facial movements will be reduced too. (11)
Hydration & Proper Diet
Proper diet and staying hydrated are essential for maintaining an attractive, wrinkle-free face and forehead. Antioxidant-rich diet stops free radicals’ damages. Staying hydrated also exfoliates skin and enhances the production of collagen and elastin. (12, 13)
Anti-Wrinkle Skincare Products
Forehead wrinkles do not appear suddenly; they develop over time. It is never too late to start using anti-wrinkle creams, serums, and treatments to enhance skin health and slow the aging signs down. (14)
Figure 1 – Image on the left is the forehead wrinkles due to prolonged exposure to the UV rays while the image on the right is the same forehead after anti-wrinkle treatment.
How to Treat Forehead Creases?
Forehead creases are usually treated using neurotoxins, but some practitioners nowadays prefer the use of dermal fillers and cold therapy. Combination treatments are also used for severe forehead wrinkles.
Botulinum Toxin Type A Injections (Botox Injections)
Botulinum Toxin Type A is a neurotoxin, which has been used for decades to treat horizontal forehead lines. It limits the contractions of facial muscles, especially in the upper face. This limitation is usually temporary; that is why the injections must be repeated every few months.
The injections do not need recovery time, but the injecting procedure should be done by an experienced plastic surgeon since it should be precise for the optimal results. (15)
Focused Cold Therapy
About 25% of people who have wrinkles do not like the idea of injecting toxins in their foreheads. Focused cold therapy is a non-surgical treatment that does not use toxins. It is effective and safe with nearly no serious side effects. Most doctors recommend it as the best alternative to common wrinkle treatments. It takes from 7 to 120 days to provide the person with a wrinkle-free forehead. (16)
Hyaluronic Acid Gel Fillers
Dermal fillers are another non-invasive, non-surgical alternative for the correction of facial defects such as forehead wrinkles. Forehead wrinkles are classified into dynamic and non-dynamic. Dynamic forehead creases respond well to Botox injections while non-dynamic wrinkles respond well to hyaluronic acid gel fillers. (17)
Laser Skin Resurfacing
Laser skin resurfacing improves skin appearance and texture. CO2 Laser Resurfacing uses light energy to get rid of superficial skin layers. It depends on minimal heat and takes 14 to 21 days to recover. Erbium Laser Resurfacing can treat deep wrinkles, but it leaves minimal burning and leads to some side effects such as redness, hotness, swelling, and minimal bruising. It is more effective than CO2 Laser Resurfacing, but it takes a longer time to recover. In addition, Erbium Laser Resurfacing is better for people with a darker skin tone. (18)
Figure 2 – Photographs showing improvement in wrinkle severity from baseline to immediately after Focused Cold Therapy. Subject at
rest, full glabellar contraction, and full frontalis contraction.
Fillers can be a useful tool if they’re used to address the underlying issues that cause nasolabial folds, explained previously. Properly correcting this cosmetic flaw requires increasing the midface volume loss, reducing skin laxity and compensating for the stretched-out ligaments. Without correctly supporting the sagging soft tissue and replacing lost volume, the problem will only return with a vengeance in due time. A routine of only dermal fillers themselves can cause the fold to migrate to the middle which is worse for aesthetics and gives the characteristic ‘botched’ look. Applying dermal fillers to this region needs special care to avoid the facial artery which is why the application is often done with multiple smaller volumes.
How QOVES Studio Can Help
Our range of skin retouching services can help you hide the appearance of a range of ageing signs among other cosmetic improvements for Instagram, commercial modelling or E-commerce productions.
Facial Aesthetics Report
Have your facial proportion and harmony be analyzed into a comprehensive report and learn about how you can improve your aesthetic.
Have our team of photo editors morph your face into more ideal proportions for a visual look at what can be achieved with surgery, exercise and muscle hypertrophy.
Find A Doctor
We’re working on building a comprehensive directory of approved plastic surgeons and practices near you that show a strong understanding of aesthetic medicine with a proven track record.
1. Dayan, S., Yoelin, S. G., De Boulle, K., & Garcia, J. K. (2019). The Psychological Impacts of Upper Facial Lines: A Qualitative, Patient-Centered Study. Aesthetic Surgery Journal Open Forum, 1(2). doi:10.1093/asjof/ojz015
2. Owen, C. M., Pal, L., Mumford, S. L., Freeman, R., Isaac, B., McDonald, L., … Wolff, E. F. (2016). Effects of hormones on skin wrinkles and rigidity vary by race/ethnicity: four-year follow-up from the ancillary skin study of the Kronos Early Estrogen Prevention Study. Fertility and Sterility, 106(5), 1170–1175.e3. doi:10.1016/j.fertnstert.2016.06.023
3. Trojahn, C., Dobos, G., Lichterfeld, A., Blume-Peytavi, U., & Kottner, J. (2015). Characterizing Facial Skin Ageing in Humans: Disentangling Extrinsic from Intrinsic Biological Phenomena. BioMed Research International, 2015, 1–9. doi:10.1155/2015/318586
4. Makrantonaki, E., Bekou, V., & Zouboulis, C. C. (2012). Genetics and skin aging. Dermato-Endocrinology, 4(3), 280–284. doi:10.4161/derm.22372
5. Flament, F., Bazin, R., Rubert, Simonpietri, Piot, B., & Laquieze. (2013). Effect of the sun on visible clinical signs of aging in Caucasian skin. Clinical, Cosmetic and Investigational Dermatology, 221. doi:10.2147/ccid.s44686
6. Flament, F., Bazin, R., Qiu, H., Ye, C., Laquieze, S., Rubert, V., … PIOT, B. (2015). Solar exposure(s) and facial clinical signs of aging in Chinese women: impacts upon age perception. Clinical, Cosmetic and Investigational Dermatology, 75. doi:10.2147/ccid.s72244
7. Oikarinen, A. (1977). Effect of cortisol acetate on collagen biosynthesis and on the activities of prolyl hydroxylase, lysyl hydroxylase, collagen galactosyltransferase and collagen glucosyltransferase in chick-embryo tendon cells. Biochemical Journal, 164(3), 533–539. doi:10.1042/bj1640533
8. Fujimura, T., & Hotta, M. (2011). The preliminary study of the relationship between facial movements and wrinkle formation. Skin Research and Technology, 18(2), 219–224. doi:10.1111/j.1600-0846.2011.00557.x
9. Freudenberg, M., Adams, R. B., Kleck, R. E., & Hess, U. (2015). Through a glass darkly: facial wrinkles affect our processing of emotion in the elderly. Frontiers in Psychology, 6. doi:10.3389/fpsyg.2015.01476
10. Mizuno, M., Kunimoto, K., Naru, E., Kameyama, K., Furukawa, F., & Yamamoto, Y. (2016). The effects of continuous application of sunscreen on photoaged skin in Japanese elderly people – the relationship with the usage. Clinical, Cosmetic and Investigational Dermatology, 95. doi:10.2147/ccid.s104392
11. Ganceviciene, R., Liakou, A. I., Theodoridis, A., Makrantonaki, E., & Zouboulis, C. C. (2012). Skin anti-aging strategies. Dermato-Endocrinology, 4(3), 308–319. doi:10.4161/derm.22804
12. Schagen, S. K., Zampeli, V. A., Makrantonaki, E., & Zouboulis, C. C. (2012). Discovering the link between nutrition and skin aging. Dermato-Endocrinology, 4(3), 298–307. doi:10.4161/derm.22876
13. Rodrigues, L., Palma, L., Tavares Marques, L., & Bujan Varela, J. (2015). Dietary water affects human skin hydration and biomechanics. Clinical, Cosmetic and Investigational Dermatology, 413. doi:10.2147/ccid.s86822
14. Sator, Paul G. “Skin treatments and dermatological procedures to promote youthful skin.” Clinical interventions in aging vol. 1,1 (2006): 51-6. doi:10.2147/ciia.2006.1.1.51
15. Zhang, X., Cai, L., Yang, M., Li, F., & Han, X. (2019). Botulinum Toxin to Treat Horizontal Forehead Lines: A Refined Injection Pattern Accommodating the Lower Frontalis. Aesthetic Surgery Journal. doi:10.1093/asj/sjz174
16. Palmer, F. R., Hsu, M., Narurkar, V., Munyon, T., Day, D., Karnik, J., & Tatsutani, K. (2015). Safety and Effectiveness of Focused Cold Therapy for the Treatment of Hyperdynamic Forehead Wrinkles. Dermatologic Surgery, 41(2), 232–241. doi:10.1097/dss.0000000000000155
17. Cazzaniga, A., Ballin, A., & Brandt, F. (2008). Hyaluronic acid gel fillers in the management of facial aging. Clinical Interventions in Aging, Volume 3, 153–159. doi:10.2147/cia.s2135
18. Janik, J., Markus, J., Al-Dujaili, Z., & Markus, R. (2007). Laser Resurfacing. Seminars in Plastic Surgery, 21(3), 139–146. doi:10.1055/s-2007-991182