Where expression lines form, and why it matters which

Movement gives a face its character, and the goal is never to remove it. But the lines left behind can make someone look tense or tired when they are neither, and that gap between how you feel and how you read to other people is usually what prompts the appointment.

The forehead

Horizontal creases across the upper forehead come from lifting the brows — in surprise, in conversation, and very often out of habit while concentrating. Some people develop them early.

The brow is also doing work here. In some faces the lift is compensating for heaviness in the upper lid, which is worth identifying before anything else is considered, because changing one affects the other.

Between the brows

The vertical lines some people call their elevens. These come from frowning, squinting and concentrating, and they are frequently the deepest lines on a face.

This is the area people most often mention, and the reason is usually the same: they feel it makes them look cross or severe when they are simply thinking.

Around the eyes

Lines that fan outward from the outer corners, linked to smiling, laughing and squinting into bright light. They are often the earliest to appear.

They are also the ones people are most divided about. A good number of patients tell me they would like to keep them and address something else. That is a perfectly reasonable position and I am not going to talk anyone out of it.

The lower face

Tension around the mouth and chin can create fine lines and a dimpled or pebbled look to the chin. Habitual gestures and speech patterns contribute, as does jaw clenching — see jaw tension and clenching if that is closer to your concern.

Who tends to book about this

Broadly, people who:

• Notice lines that are visible when the face is completely relaxed.
• Feel their resting expression reads as tense or tired.
• Want to look at this conservatively rather than dramatically.
• Would rather nobody could tell they had done anything.

It is not appropriate for everyone. It is not suitable during pregnancy or breastfeeding, or alongside certain conditions affecting nerves or muscles. A full history is taken before anything is discussed, and part of the point of that history is to identify when the answer should be no.

What happens at the appointment

I assess your movement, your skin and the areas that concern you, at rest and in animation. I ask what bothers you and what you would like left alone — that second question matters more than people expect.

Where something is appropriate, I explain what it would involve, what the risks are, and what the first few weeks look like. Results vary between individuals and nothing is permanent. Options are discussed in the appointment rather than advertised beforehand, and there is no expectation that you proceed on the day or at all.

This article explains a process. It is general information, not clinical advice, and it is not a recommendation for any particular treatment. Whether anything is suitable for you is a matter for individual assessment.