By Doctor Claude Aharoni
Former medical faculty registrar and head of research. Member of the French Society of Plastic, Reconstructive and Aesthetic Surgery.
The source of our expressions and intellect, the forehead can illuminate the eye area or, conversely, make it look worried or tired. It is part of an ensemble that plays a very important – though often neglected – role in projecting the image that we want to convey. Creased, wrinkled, flattened or weak foreheads can be corrected using botulinum toxin and/or certain hyaluronic acids.
Opening up the eye area without changing the expression
When we perform a procedure on the forehead, it is actually the eye area that we are looking to change. The main quality that we look for in botulinum toxin is high precision, so that it alters the eyebrow in a specific way. The more precise the toxin is (with regard to not spreading away from the injection site), the closer we can place it to the lower part of the forehead without weighing down the eyelids or eyebrows. If we block the upper part of the frontal muscle, the lower part has to work twice as hard, resulting in an altered expression and the infamous “Spock” or “Mephisto” effect. Bocouture from Merz Laboratories is my preferred product because it is the most precise toxin on the market and suits patients who do not want a completely smooth forehead. In France there are two different schools of thought with regard to criteria for beauty: those who want a subtle result, and those who want their forehead to catch a maximum of light, something we can only achieve by smoothing it. This is why Merz obtained an AMM (marketing authorisation) for the whole forehead. This precision enables us to control the result to the closest millimetre, but requires more injection points. The particular character of Bocouture is that it does not dissipate, meaning that we can custom-treat each patient’s forehead without the side-effects of a somewhat “frozen” appearance and sunken eyebrows, which make the person look sad and can hinder the eyebrows’ function for a few weeks.
The fact that this is the only pure toxin that is free from complexing proteins means that there is no resistance to treatment. Certain patients (around 4%) do not respond to toxins or, after a few years, the toxins no longer work in certain patients because their bodies have created antibodies to defend themselves from this foreign protein complex, which Merz has now managed to eliminate.
Plump, reshape, smooth
In 20% to 30% of patients, especially in men, botulinum toxin in the forehead lines makes the eyebrows droop and weighs the expression down; we achieve the opposite result to what we were hoping for, and even more so if the wrinkles are low and very deep. In this case, we must preserve the muscle activity in the forehead, and this is where the Blanching Technique comes into play, using Belotero Balance or Soft, which enables us to fill the wrinkles by injecting superficially. Its double cross-linked technology guarantees the product’s perfect integration into the superficial tissues, with natural and undetectable results that will last for around 18 months. We are thus able to reshape the forehead, either by rounding it out to make it look more feminine, or by restructuring it (if it has become flattened or weakened) by correcting the angle of its slope. Thanks to its unique rheology, Belotero Volume is easily integrated into the areas that need filling, projecting and firming up, without looking fake or artificial. I inject it deeply, right to the bone, and massage it in to achieve the desired shape. The procedure is comfortable thanks to the lidocaine included in the product and the 30G needle used. It is sometimes necessary to complement this procedure by filling the temporal fossae, which rejuvenates and softens the face. This action can be enhanced with a few pricks of toxin. The forehead once again catches the light, which breathes life back into the expression.
