<p>A Novel OnabotulinumtoxinA Treatment Technique to Obtain Predictable Outcomes in Eyebrow Position and Shape</p>

Abstract

Background OnabotulinumtoxinA has been approved for multiple clinical and dermatological indications. The toxin, produced by the bacterium Clostridium botulinum , is undoubtedly the most widely used cosmetic treatment for both the reduction and prophylaxis of wrinkles in the upper face and the reshaping of the eyebrows. However, the aesthetic outcomes obtained with respect to eyebrow position and shape are not always predictable and furthermore, untoward effects such as eyelid and brow ptosis are sometimes seen. Objective This article suggests a novel injection technique of the upper face with OnabotulinumtoxinA to obtain predictable and reproducible results with respect to eyebrow position and shape, whilst greatly minimizing the risk of adverse effects such as brow and lid ptosis. Discussion OnabotulinumtoxinA inhibits the release of acetylcholine and results in the temporary paralysis of skeletal muscle. The aesthetic outcome of wrinkle reduction typically lasts for a period of 14–16 weeks. Although relatively safe in that the toxin does not have any irreversible side effects, even a temporary untoward reaction may be seriously distressing to the cosmetic patient. Conclusion The proposed injection technique, when diligently followed, ensures that the final eyebrow position is pleasing and symmetrical with a negligible risk of any untoward effects.

Aesthetic implications of depressor supercilii muscle block with botulinum toxin type A

“…The following is a descriptive observational study of the case report type describing the correction of oblique frown lines and the subjective sensation of flattening of the glabella and distancing of the eyebrows after the application of botulinum toxin on the depressor supercilii muscle. A narrative literature review was carried out using the combination of the terms 1 : depressor supercilii and 2 botulinum toxin. The databases used in the research were as follows: LILACS, EMBASE, Medline, Web of Science, Google Scholar, and Scopus.…”

“…Additionally, it is very useful for modifying the shape and positioning of the eyebrows. 1,2 The procedure is minimally invasive, and the results are optimal if the toxin is applied correctly under the precepts of aesthetics, technique, and facial anatomy. 2 For the application of botulinum toxin type A on the upper third of the face, it is important to consider the balance between the elevator and depressor muscles of the eyebrows, the frontalis muscle being the main elevator and generator of the horizontal lines of the forehead, as well as the muscles of the glabellar complex and the orbital portion of orbicularis oculi which depress the eyebrows and cause frown lines.…”

“…Botulinum toxin type A is derived from several strains of the bacterium Clostridium botulinum and is a very safe non‐surgical cosmetic tool for the treatment and prophylaxis of facial wrinkles due to muscle contraction by inhibiting the release of acetylcholine and generating a relaxing effect in the muscle for a period of 14–16 weeks. Additionally, it is very useful for modifying the shape and positioning of the eyebrows 1,2 2 …”

Botulinum Toxin Type A: Adverse Events and Management

“…A too depressed position of the injection sites, in absolute terms or relative to the subject, is what leads to such an unfavorable outcome. 18 19…”

“…A too depressed position of the injection sites, in absolute terms or relative to the subject, is what leads to such an unfavorable outcome. 18,19 The candidate subjects with some degree of upper dermatochalasis or eyebrow ptosis at baseline deserve special attention. Increasing the safety margin in these individuals needs to leave a more comprehensive section of the caudal frontalis muscle free to contract.…”