The Importance of the Frontalis Muscle for Eye Strain and Facial Appearances

 

One of the most common problems seen at the Center For Facial Appearances in Sandy Utah are patients who are concerned with wrinkling of the forehead, heavy or droopy eyebrows, complaints of visual fatigue, or difficulty with vision when tired.  All of these problems may be caused by the frontalis muscle.

The frontalis muscles are a pair of vertically oriented muscles in the forehead that lift the eyebrows.  When one contracts the forehead muscle it causes elevation of the brows with simultaneous development of horizontal wrinkles in the forehead.  

When patients first develop enough excess of skin in the upper eyelid they reflexively begin contracting the frontalis muscle to pull the brows up and simultaneously pull up the eyelid skin so that it no longer touches the eyelashes.  This reflex were patients contract the frontalis muscle to keep the eyelid skin off of the eyelashes causes the frontalis muscle to fatigue which patients will describe as visual fatigue, heavy eyelids or eyebrows.

In some patients Botox injections can be used to relax the frontalis muscle to get rid of forehead wrinkles. Relaxing the frontalis muscle with Botox causes the brows to drop. Dropping the eyebrow can exacerbate the problem where the eyelid skin rest on the eyelashes.   If the central brow is in a good position it is possible to only give the Botox in the center for the forehead or high on the forehead to prevent the outer part of the brow from dropping. Giving Botox over the crows feet area also tends to lift the brow a bit.  However, in some situations the only solution to get rid of the horizontal wrinkles in the forehead and lift the excess skin off of the eyelashes is a blepharoplasty combined with a surgical lift of the brow.    I have many patients in my practice who I have managed with Botox for years whom with the passage of time develop descent of the brow which can no longer be managed with Botox and then undergo eyelid surgery plus an Endoscopic Forehead Lift, Pretrichial Brow Lift, or some other procedure to surgically elevate the brow.

In some cases the eyebrows can sit so low that they put the eyelids in a position where the superior field of vision and even light coming through the pupil will be blocked.  The eyelids are connected to the eyebrows and the eyebrows are connected to the forehead. So if one has a droopy forehead which causes the eyebrows and eyelids to droop to the point where it impacts vision then a brow lift may even be considered medically necessary.  In these cases patients will typically be bothered with vision when tired. The reason for this is that the brain reflexively tells the frontalis muscle to contract to hold the brows up all day long so the patient can see. However, late in the evening the frontalis muscle fatigues and can no longer hold up the brows such that the lids drop and obscure peripheral and even sometimes central vision.  In these cases patients often report symptoms are worse when doing an activity in the evening that they find relaxing like driving a car, watching TV, or reading. In these severe cases medical insurance may even pay for a direct brow lift, although depending on the patient’s hairline a superior cosmetic result may be obtained with an endoscopic forehead lift or a pretrichial brow lift.

If you are having trouble with wrinkling of the forehead, heavy or droopy eyebrows, visual fatigue, or difficulty with vision when tired then contact The Center For Facial Appearances at 801-997-9999 to discuss options available to help you.

 

By John McCann, MD, PhD

Posted in: Uncategorized

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