28/03/2026
🤨” Forehead Wrinkles: A Small Price for Keeping Your Eyes Open”
Ocular aesthetic - Dr Chua 28/3/2026
I recently saw two patients in clinic with a similar concern (Fig. 1).
Both had undergone Botox treatment for forehead wrinkles elsewhere.
Both came back with the same complaint:
“Doctor, my eyelids feel heavy… and my eyes look smaller.”
A familiar story—and an important lesson.
⸻
🧠 Meet the Frontalis — Your Built-In Brow Lifter （Fig. 2)
The frontalis muscle is the only muscle in the face that lifts the eyebrows.
And when your eyebrows go up…
your eyes open.
In many people, this muscle quietly does the job of
compensating for droopy or heavy eyelids.
⸻
👀 When Wrinkles Are Actually Doing You a Favour
In patients with:
• Droopy eyelids (ptosis)
• Excess eyelid skin (dermatochalasis)
…the frontalis works a little harder (Fig. 3)
It lifts the brows to:
➡️ help you see better
➡️ reduce that “heavy eyelid” feeling
➡️ keep the eyes looking more alert
Those horizontal forehead lines?
They are not merely age.
They are effort.
⸻
💉 The Botox Misadventure
When Botox is used too aggressively on the forehead:
• The frontalis is weakened or paralysed
• The eyebrows drop
• The eyelid skin descends further
And the result:
👁️ Eyes appear smaller
👁️ Lids feel heavier
👁️ The natural eyelid crease may disappear
In trying to remove the wrinkles…
we remove the very mechanism that was helping the eyes stay open.
⸻
🔍 A More Thoughtful Approach
Here’s the part that is often overlooked.
If the forehead wrinkles are caused by the frontalis overworking to lift heavy eyelids,
then one solution is not to weaken the muscle—
but to remove the cause of that overwork.
⸻
✨ Treat the Cause, Not Just the Lines
Conditions such as:
• Dermatochalasis (excess eyelid skin)
• Ptosis (droopy eyelid muscle)
• Puffy eyelids (heavy eyelid)
can be addressed with:
• Blepharoplasty (eyelid surgery)
• Ptosis correction (Fig. 4)
• Double eyelid surgery with fat removal (Fig. 5)
By lightening the eyelids or restoring their position:
✔️ The eyes open more naturally
✔️ The frontalis no longer needs to overcompensate
✔️ Forehead wrinkles may soften without paralysing the muscle
In other words—
you reduce the wrinkles by removing the reason they formed in the first place.
⸻
⚖️ A Matter of Balance
Good aesthetic treatment is not about chasing a perfectly smooth forehead.
It is about preserving:
• Function
• Expression
• Natural eye opening
✔️ Soften, don’t erase
✔️ Preserve some frontalis strength
✔️ Respect the role of the muscle
⸻
🧩 A Quiet Truth
Not all wrinkles are the enemy.
Some are simply the visible signs of a muscle doing its job—
rather diligently, in fact.
⸻
A small reminder:
In the face, as in life, it is often wiser to ask why something exists…
before deciding to get rid of it.
😳🧐🤨😉😳🧐🤨😉😳🧐🤨😉 😳🧐🤨😉😳🧐🤨😉😳🧐🤨😉 😳🧐🤨😉😳🧐🤨😉😳🧐🤨😉
🤨《额头皱纹：其实是在帮你把眼睛撑开》
眼部美学 - 蔡鐘能眼科医生28/3/2026
最近我在门诊看到两个很相似的病例 （图1）。
两位病人之前都去打了额头Botox。
回来时都有同一个投诉：
“医生，我的眼皮变很重，眼睛也变小了。”
其实，这种情况并不少见。
⸻
🧠 认识一下：Frontalis（额肌）
额肌是脸上唯一可以把眉毛抬高的肌肉 （图2）。
眉毛一抬高——
眼睛就会比较打开。
很多时候，它是在默默帮你
补偿下垂或厚重的眼皮。
⸻
👀 有些皱纹，其实是在帮你
如果你有：
• 上眼皮下垂（ptosis）
• 眼皮皮肤多、松（dermatochalasis）
额肌就会特别努力 （图3）。
它会帮你：
➡️ 把眉毛抬高一点
➡️ 让你看东西更清楚
➡️ 让眼睛看起来比较有精神
所以额头那些横纹——
不只是老化。
是用力撑出来的。
⸻
💉 Botox打太多的问题
如果额头Botox打太多：
• 额肌被削弱甚至“打死”
• 眉毛掉下来
• 眼皮跟着更往下
结果就变成：
👁️ 眼睛看起来更小
👁️ 眼皮更重、更盖
👁️ 双眼皮线可能都不见
本来是想变年轻，
结果反而看起来更累。
⸻
🔍 更聪明的处理方法
很多人忽略了一点：
如果额头皱纹是因为
额肌在“拼命帮你撑眼睛”，
那重点不应该是把它打掉，
而是解决它为什么要这么辛苦。
⸻
✨ 处理根本原因
像这些情况：
• 眼皮皮肤过多（dermatochalasis）
• 眼皮下垂（ptosis；图4）
• 眼皮肿（puffy eyelids；图5）
可以通过：
• 眼皮整形（blepharoplasty）
• 提眼肌手术（ptosis correction）
• 双眼皮手术加去除脂肪（Asian blepharoplasty and fat removal）
当眼皮变轻、位置恢复：
✔️ 眼睛自然打开
✔️ 额肌不需要再过度用力
✔️ 额头皱纹也会自然减少
也就是说——
不是靠“打掉肌肉”，
而是把原因解决掉。
⸻
⚖️ 重点是平衡
好的治疗，不是把额头变得完全没有表情。
而是要：
✔️ 皱纹淡一点就好
✔️ 保留一点额肌力量
✔️ 眼睛保持打开、有精神
⸻
🧩 小小体会
不是所有皱纹都是坏的。
有些，其实是在帮你“顶住场面”。
如果全部消掉，
你才会发现——原来它们一直在帮你做工。
⸻
一句简单的话：
在脸上，很多时候不是要“去掉”，
而是要先了解——它为什么会存在。
#蔡鐘能眼科医生 #马来西亚眼科医生 #国际眼科中心 #古晋眼科中心 #诗巫眼科中心 #额头皱纹
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