Every feature plays a role in facial harmony. When it comes to the upper third of the face, we often devote our time and attention to the eyes and the brows – but what about the forehead? The area from the hairline to the brow bone holds a lot of prominence and conveys a lot of emotion, which is why it can have such an impact on the overall proportion of the face. And, like so many other facial features, there is no singular forehead concern or procedure to treat it. From a forehead reduction to Botox, there are both surgical and non-surgical solutions to address a myriad of forehead-related aesthetic concerns. Here’s what you need to know.
Based on its size alone, the forehead has always been at the forefront of the face. But nearly two years of wearing pandemic-related face coverings has put a spotlight on it in a new way. “With the COVID-era and mask use, the upper face is more noticeable than ever,” says Samer Jaber, MD, a board certified dermatologist and founder of Washington Square Dermatology in New York City.
Unlike lip volume or brow fullness, there aren’t really aesthetic ‘trends’ related to the appearance of the forehead. Instead, patients and providers alike are looking at it relative to the face as a whole. “While there is no universal perfect forehead size, having a forehead that is proportional to the rest of your face can make you feel more attractive,” Dr. Jaber says. Generally speaking, “in an ideal appearance, the forehead should make up one-third of the face and should be approximately equal in size to the midface and the lower face,” explains Rebecca Marcus, MD, a board certified dermatologist in Dallas, TX. “This rule of ideal proportions is called the Golden Ratio.”
Aesthetic Forehead Concerns
Now that you have a better sense of how the forehead relates to the rest of the face, it’s time to talk about the specific aesthetic concerns that people often have about the feature. “The most common general concerns are related to volume loss seen in the temporal region,” says Amir Karam, MD, a board certified facial plastic and reconstructive surgeon and founder of KaramMD Skin. “Volume loss can cause the temples to sink in to give it a more hollow look making the face look bonier.” Dr. Marcus, meanwhile, regularly sees patients who believe their forehead “may be too wide, too narrow, too short, or too long.” Additionally, the hairline may be encroaching, receding, or uneven.
And then there is the skin of the forehead. You’ll be hard pressed to find someone who doesn’t have any horizontal forehead lines (unless, of course, they’ve long been a neurotoxin devotee). These expression lines are caused by the constant movement of the frontalis muscles, the pair of vertically oriented muscles that lift the eyebrows. Furthermore, “the skin on the forehead can also overproduce oil or possess enlarged oil glands, known as sebaceous hyperplasia, which would manifest as small bumps in the skin,” Dr. Marcus adds.
Regardless of what’s bothering you about your forehead, there are both surgical and non-surgical solutions that can address the shape, size, and skin.
Surgical Forehead Procedures
In general, surgical procedures yield the most dramatic and lasting results. Depending on your forehead concern, they may be the best option. Below are three of the most common:
A browplasty (a.k.a. forehead lift or brow lift) is a cosmetic surgery that can address the positioning of the eyebrow, which, in turn, enhances the forehead. While there are different types of brow lifts that each carry varying degrees of invasiveness and scarring, surgical brow lifts can reposition the brow, remove excess skin and fat, and tighten the muscles in the forehead area. This combination can minimize the appearance of forehead lines, soften frown lines, and restore a more youthful brow. It can be performed alone or to complement a blepharoplasty, facelift, or other facial procedure. For patients who have exhausted the so-called Botox brow lift, Dr. Jaber says “a surgical brow lift with a plastic surgeon could be pursued for a more dramatic effect.”
2. Hair Transplant
Whether you realize it or not, your forehead and hair are inextricably linked. After all, the shape of your hairline directly affects the shape and size of your forehead. If you are concerned about a receding or uneven hairline, a hair transplant may be for you. “Hair transplants, when done well, look wonderful and make a huge impact on one's confidence,” Dr. Marcus shares.
Follicular unit extraction (FUE) involves transplanting individual hair follicles from the back of the head to the front to create a new hairline. This technique generally works best for people with short hair. Follicular unit transplantation (i.e. strip harvesting), meanwhile, is usually the preferred method for those with longer locks. Rather than explanting one at a time, a strip of follicles is taken from the rear of the head and then distributed to thinning or balding areas.
In either case, you’ll need to be patient as the transplanted follicles establish themselves and start to grow. You’ll see initial results in about six months, with the full effect visible 12 to 18 months post-op.
3. Forehead Reduction
While celebrities like Naomi Campbell and Vanessa Paradis are known for their larger foreheads that perfectly complement their facial features, not everyone is comfortable with the size of theirs. If your forehead is larger than you’d like, a forehead reduction may be in order for the right candidate. “With a forehead lowering procedure, an incision is made at the hairline from ear to ear,” Dr. Karam says. As he explains, one to two centimeters of skin are removed and the entire scalp is advanced forward. “The downside is that it’s surgery and will have a scar at the hairline, but, otherwise, it is effective in creating the right proportions,” he adds. It can be a solution for those with a naturally strong hairline that needs to be lowered, but it’s not applicable for those who have had a coronal brow lift or strip harvesting.
Non-Surgical Forehead Treatment Options
Whether you’re not quite ready to go under the knife or you want to treat something that doesn't require cutting, here are some of the best non-surgical procedures to address aesthetic forehead concerns.
1. Laser Hair Removal
We talk a lot about receding hairlines, but hair loss isn’t always the issue when it comes to the appearance of the forehead. “If the hairline is too low, removing hair at the hairline could help the forehead to appear larger,” Dr. Marcus explains. Laser hair removal can provide the necessary reprieve, and celebrities like Kim Kardashian have admitted to seeking this solution. The process is virtually painless, though it does require multiple sessions before the final result is achieved. While the technology has come a long way, it’s not an option for everyone. Those with darker skin tones or lighter hair colors may not be candidates. Electrolysis may be an alternative.
We’re all familiar with wrinkle-smoothing benefits of Botox®, Dysport®, Jeuveau®, and Xeomin®, and one of their most beloved applications is for horizontal forehead lines. While neurotoxins can be injected directly into said wrinkles, strategic placement can yield an even more rejuvenating effect. “Botox® can be strategically injected to lift the medial and lateral portions of the eyebrows and help the forehead to appear more open and lifted,” Dr. Marcus says. “This is one of my favorite ways to provide a patient with a quick freshening up.” The minimally invasive solution not only softens the appearance of existing lines by temporarily ‘freezing’ the underlying muscles, but it also helps prevent further deepening.
3. Non-Surgical Skin Tightening & Resurfacing
If skin tone, skin texture, or skin quality are a concern, there are additional non-surgical skin tightening and skin resurfacing treatment options that can address the forehead and beyond. “Procedures such as radiofrequency, microneedling, and Ultherapy® can be used to stimulate collagen production,” Dr. Jaber says. “If the concern is to smooth out forehead wrinkles, resurfacing lasers such as Fraxel® or CO2 can be considered.”
4. Dermal Filler
When it comes to restoring lost volume, dermal filler is often viewed as a time machine. As it relates to the forehead, however, you’ll want to proceed with caution. Dr. Karam does not recommend filler in the region because of how expressive it is. “This is an area where the muscles move, so putting filler into this area can be ineffective and lead to clumping or irregularities,” he cautions. Dr. Jaber agrees. “If you are going to do forehead filler, make sure to discuss potential risks with the injector prior to the procedure,” he says. “To soften forehead wrinkles, I recommend regular use of Botox®.”
What you may not realize, however, is that injecting filler into other areas can have a big impact on the face as a whole. “If you feel like you have a large forehead, then defining your lower face with procedures like chin filler or jaw filler can improve your facial proportions, making you feel more attractive,” Dr. Jaber explains. This holistic approach is why it is so important to visit a board certified dermatologist or plastic surgeon. They will be able to give you a complete assessment of what’s possible based on your anatomy and aesthetic goals.
One last tip...
Fellas take note: facial hair can be one of the quickest and cheapest ways to refresh your look. “If you don't want to do any procedures, then a simple option for men is growing a beard,” Dr. Jaber notes.
Aesthetic goals and perceptions of beauty are as unique as fingerprints. “Even if a feature falls outside of these classic definitions of facial harmony and beauty, it doesn’t equate to an objective lack of beauty,” Dr. Karam emphasizes. But, if you are interested in addressing the upper third of the face, it’s helpful to remember that the region is more than the eyes and brows. Consulting with a board certified dermatologist or plastic surgeon will allow you to learn more about what treatment options may be best for you.
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