The era of the frozen forehead may be thawing. After years of chasing a perfectly smooth, line-free complexion, more patients are heading into their injectors’ offices with a different goal: keep the wrinkles that make them look like themselves and soften only the ones that don’t. Dubbed “strategic wrinkles,” the approach aims to use neurotoxin selectively instead of freezing out every line, thereby preserving expression. The goal? Ease the furrows that make you look tired, stressed or perpetually annoyed while leaving the lines that light up when you laugh.
“There is a cultural reset in aesthetics in which the natural look is the coveted look,” says Washington, D.C. dermatologist Nina Hartman, MD. And, as Southlake, TX dermatologist Janine Hopkins, MD puts it, “A beautiful result can absolutely include wrinkles. A face can look healthy and refreshed and still move.”
Featured Experts
- Nina Hartman, MD is a board-certified dermatologist in Washington, D.C
- Janine Hopkins, MD is a board-certified dermatologist in Southlake, TX
What Are Strategic Wrinkles?
Strategic wrinkles refer to preserving certain expression lines while softening others with neurotoxin treatment, Dr. Hopkins explains. “I think the interest reflects a desire to look natural and less visibly treated. Preserving expression has long been part of thoughtful cosmetic dermatology; the terminology is new.”
Some lines are worth keeping, says Dr. Hartman. “They convey warmth, personality and authenticity. Moreover, preservation of movement looks more natural, and complete paralysis can make someone look odd and older than their age.”
Are Patients Asking to Keep Some Wrinkles?
While most patients don’t specifically ask to keep wrinkles, they often express that they “want negative expression lines softened while preserving pleasant animation. They tell me they don’t want to look mad or sad when they aren’t feeling that way,” says Dr. Hopkins. “I like to ask, ‘Which lines bother you, and what do you love about your face?’ That helps us soften an unintended frown while keeping the warmth of a smile.”
Which Wrinkles Do Patients Want to Keep?
For many, it’s the lines around their eyes. “The most common areas people want to preserve are the crow’s feet, or the lines around the eyes that result from smiling,” says Dr. Hartman. “These lines are tied to warmth and happiness. A big smile reads as authentic, and patients are increasingly aware that eliminating the crow’s feet entirely can make the smile look less natural and flat.”
Can Selective Neurotoxin Treatment Look Uneven?
Yes, if an injector doesn’t account for how the surrounding muscles move. “Facial muscles work together, so we cannot simply chase individual wrinkles,” Dr. Hopkins explains. “Treating one part of the forehead without accounting for the remaining activity can create uneven movement or an exaggerated brow arch. Overly weakening the forehead can also cause brow heaviness because that muscle helps support the brows. Anatomy, placement and dose all matter.”
Dr. Hartman agrees: “There are always risks in injecting muscles without understanding how the surrounding muscles will change or compensate. This is where the skill of the injector becomes critical. For example, treating the forehead without the glabella or ‘11 lines’ can lead to new, diagonal lines along the forehead. Similarly, partially treating the forehead without careful planning can result in a Spock-like elevation of the lateral brow. The key is a thorough understanding of facial anatomy and a very individualized injection strategy. It’s not simply about using less product—it’s about placing it with precision.”
How Do Injectors Decide Which Lines to Treat?
“Our approach always starts with an in-depth conversation about what the patient values and wants, followed by a thorough evaluation of his or her anatomy. From there, we use a ‘less-is-more’ philosophy, often starting conservatively,” says Dr. Hartman. “It is much more preferable to have a patient return for a touch-up than to be overtreated.”
Dr. Hopkins starts consultations by listening to patients and watching how their faces move at rest and as they talk, smile and frown. “I assess muscle strength, brow support and any existing asymmetry alongside their goals,” she explains. “My goal is to soften expressions that unintentionally communicate anger or sadness while preserving warmth and personality. A successful result should still look and feel like you,” says Dr. Hopkins.
