When deciding to get forehead Botox, many people only think about the "forehead muscle" (frontalis). However, in clinical practice, even with the same dose in the exact same spot, the results vary greatly from person to person. One person might get a perfectly smooth forehead with only their horizontal wrinkles gone, while another might feel like their eyes have become smaller and heavier. This difference occurs because the "accustomed division of labor" among three muscles—the frontalis, levator palpebrae superioris, and orbicularis oculi—varies for everyone.

Three muscles are involved in your forehead Botox outcome

Although forehead Botox is injected only into one area—the forehead—three muscles directly influence the final look. From the top, we have the frontalis*, just below it inside the upper eyelid is the levator palpebrae superioris*, and wrapping gently around the eyes is the orbicularis oculi.

These three muscles work together to share the load of "raising the eyebrows, lifting the eyelids, and moving the eye area." To receive forehead Botox safely, we first need to assess how these three muscles divide their workload in your unique face.

* Frontalis: A large muscle covering the entire forehead. When it contracts, it lifts the forehead upward. While it is the cause of horizontal wrinkles, it also plays a supporting role in lifting the eyebrows and eyelids to widen your field of vision.

* Levator palpebrae superioris: The muscle attached to the upper tarsal plate. It is the "true eye-opening muscle" responsible for consciously opening your eyes. It lifts the eyelids independently of the forehead.

The frontalis creates wrinkles, but it also helps lift the brows and eyelids

While the frontalis is commonly known simply as "the wrinkle-making muscle," clinically and anatomically, it also serves as an "assistive muscle" that helps lift the eyebrows and upper eyelids. Think of it like two people carrying a heavy book together. The primary lifter is the levator palpebrae superioris, but when you feel like your vision is a bit narrow, the frontalis lends a helping hand.

This isn't always obvious in daily life. Try opening and closing your eyes slowly in front of a mirror and watch to see if your eyebrows rise slightly as you do. If they do, it means your frontalis is doing a lot of assistant work on a daily basis.

The levator palpebrae superioris is the "real eye-opening muscle"

Because the levator palpebrae superioris is located deep inside the upper eyelid, we do not directly paralyze it with Botox. Since this muscle is responsible for consciously opening the eyes, unlike the frontalis, it is closer to a "functional" muscle rather than an "expressive" one.

If you have a strong levator muscle, you can open your eyes perfectly well on your own even after forehead Botox, without any help from the frontalis. On the other hand, those with relatively weaker levator muscles or those whose upper eyelids have extra skin that partially blocks their vision (common in monolids) rely heavily on the support of the frontalis. This difference is the core reason behind that "heavy eyes" feeling after forehead Botox.

The orbicularis oculi is for closing the eyes and fine wrinkles

The orbicularis oculi muscle is responsible for "closing" the eyes. It is the culprit behind blinking, squeezing your eyes shut, and the fine lines around the eyes when you smile (crow's feet). Because it works in the exact opposite direction of the frontalis, it doesn't directly clash with forehead Botox.

However, if you receive eye Botox (which paralyzes the upper part of the orbicularis oculi) at the same time, the burden on the frontalis to assist with lifting becomes even greater. If you are a frontalis-dependent type and receive both forehead and eye Botox on the same day, balancing the dosage becomes much trickier.

The balance between these three determines your forehead Botox results

To get the best results from forehead Botox, you first need to understand how you normally use these three muscles. Here is a quick summary table.

When the frontalis is paralyzed, that "helping hand" disappears. If your levator muscle is strong enough, you will barely notice a difference. However, those who have relied heavily on the frontalis will feel their eyelids become heavy and their field of vision narrow. This is the true nature of "pseudoptosis," which we will cover in the next post.

Frequently Asked Questions

Q. Does forehead Botox make everyone's eyes feel heavy?

No, it doesn't. People with a sufficiently strong levator palpebrae superioris (common in those with double eyelids) experience very little difference in opening their eyes, even if the frontalis is paralyzed. Only those who have heavily relied on the frontalis for support will feel a sense of heaviness. In our next post, we will share the mechanism behind this and a self-diagnosis method.

Q. Is it normal for my eyebrows to lift slightly when I open my eyes?

The degree of movement varies from person to person. Some people's brows barely move, while others always lift their brows. The latter is a pattern showing high dependency on the frontalis. Looking at your facial expressions in everyday photos or videos is a great way to figure out which type you are.

Q. Can I get forehead Botox and eye Botox on the same day?

Yes, you can. However, if you are frontalis-dependent, rather than getting both treatments on the same day, it is much safer to get one treatment first, observe the results in 2 to 3 weeks, and then decide on the next treatment.

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