Which Neurotoxin Is Best for Forehead Lines?

Botox Cosmetic is FDA-approved for forehead lines, and two large forehead trials back it. Daxxify, Xeomin, Dysport and Jeuveau are also injected into the forehead, but their faster or longer-lasting results come from studies of the frown lines between the brows, not the forehead. For a smoother forehead, Botox Cosmetic has the proof, and the number of units you get decides much of how long it lasts and what you pay.

Which neurotoxin is FDA-approved for forehead lines?

Botox Cosmetic. Its FDA label covers temporary improvement of moderate to severe forehead lines in adults. It also covers the frown lines between the brows, crow's feet and neck bands. The FDA approved it for forehead lines in October 2017.

The forehead trials behind that approval are large. In the dose-finding study of 175 people (mostly women, average age about 47), investigators rated forehead lines as none or mild at day 30 in 91.2% of the 40-unit group and 86.4% of the 30-unit group. In two phase 3 trials with 1,178 people, more people improved on Botox than on placebo at day 30, and the results held through three rounds of treatment (forehead lines review).

Daxxify is often sold as the longer-lasting option. Its Medication Guide covers frown lines between the eyebrows and a neck muscle condition called cervical dystonia. It does not cover forehead lines.

Do Daxxify, Xeomin or Dysport work better on the forehead?

We found no trial that compares brands head to head on the forehead. Every brand comparison below comes from the frown lines between the brows, also called glabellar lines. Those results may not carry over to your forehead.

Here is what the frown-line studies found:

• Daxxify: In a phase 2 trial of 268 people, 40 units of Daxxify lasted a median of 24 weeks. Twenty units of Botox lasted 19 weeks. The difference was statistically significant.
• Xeomin, Botox and Dysport: In a trial of 180 people (mostly women, average age 40), women first saw Xeomin work at a median of about 3 days. Botox and Dysport took about 5.3 days. The trial used 21 units of Xeomin, 21 units of Botox and 63 units of Dysport.
• How long those three lasted: In the same trial, the effect lasted a median of about 140 to 146 days in women for all three brands. The brand made only a small difference to how long it lasted.

How many units does a forehead need, and what does it cost?

The Botox Cosmetic label doses the forehead together with the frown lines: 40 units in total. In the trials, that was 20 units in the forehead and 20 between the brows.

More units lasted longer. The 40-unit dose held up longer than the 30-unit dose, and both doses kept beating placebo through day 180 (forehead lines review). A light dose can look like a bargain on the day and wear off sooner.

Units don't convert between brands. Each brand's FDA prescribing information says its units can't be converted into units of any other botulinum toxin. A cheaper price per unit doesn't always mean a cheaper visit, so ask for the total.

At the median price of $12.50 a unit across 108 clinics, the labeled 40-unit forehead and frown-line dose comes to about $500. Most of those clinics charge $10 to $14.50 a unit, so expect to pay about $400 to $580. One price guide puts the forehead alone at about 20 units, or $195 to $295.

Cosmetic Botox is generally not covered by insurance, and you generally can't pay for it with HSA or FSA funds.

Can forehead Botox make my eyebrows droop?

It can, but it's uncommon. Over 12 months in the forehead trials, 2.6% of people had a drooping eyebrow and 1.8% a drooping eyelid. Side effects of any kind showed up in 20.2% of people on Botox and 10.2% on placebo, and bruising at the injection site was among them (forehead lines review).

The forehead trials left out people whose brows already droop, who have loose skin on the forehead or brows, who have eyelid folds that reach the pupil or touch the upper lash line, or who use the forehead muscle to lift their eyelids. If that sounds like you, tell your injector before they start.

Every neurotoxin label carries a warning that the effect can spread beyond the injection site. The Botox Cosmetic label also says there have been no definite serious reports of spread at its labeled cosmetic doses, including 40 units for the forehead and frown lines. Tell your injector right away if you have trouble swallowing, speaking or breathing.

Botox Cosmetic can also dry your eyes. Report eye pain, irritation, light sensitivity or changes in your vision.

If you're pregnant or breastfeeding, the Daxxify Medication Guide says it is not known whether it can harm a baby or pass into breast milk. One mom-to-be on Reddit planned to wait: "I'll resume Botox after nursing as well."

What should I ask before booking forehead Botox?

• Which brand am I getting? Write it down. The Daxxify Medication Guide tells patients to say whether they've had any other botulinum toxin product in the last 4 months and to make sure the provider knows exactly which one.
• How many units go in my forehead, and are my frown lines treated too? Then ask for the total price, not the price per unit.
• Was that shown on the forehead? If a brand is pitched as faster or longer-lasting, ask whether that result came from the forehead or only from between the brows.
• Can I say no to extra areas? Yes. One bride-to-be on Reddit went in for her neck bands and wrote, "During the appointment she kept insisting that I should address my 'eye wrinkles'." She added: "At least 4 separate times I had to tell her no, I'm good."

Injections relax the forehead muscle, but your skin between visits is up to you. Hot or Nothing doesn't offer neurotoxin injections. Instead, take the quiz to build a skin plan with our clinical team, who can prescribe tretinoin or GHK-Cu copper peptide if either fits your goal.