Temporal Brow Lift Using Botulinum Toxin A

Abstract

The objective of this study was to determine whether brow elevation occurs as a result of paralysis of brow depressors after botulinum toxin A injection. The study's design was a prospective case series with pretreatment and posttreatment outcome evaluation with statistical analysis at a university-based division of facial plastic surgery private clinic. Twenty-two patients of a consecutive sample desiring a cosmetic enhancement underwent injection of botulinum toxin A directed to brow depressors. Injections consisted of 7 to 10 units of botulinum toxin A (Botox, Allergan, Irvine, Calif.) into selected brow depressor muscle (lateral orbicularis oculi) bilaterally. No patients withdrew for adverse effects. All patients were evaluated 2 weeks after treatment. The outcomes were measured by change in brow elevation along vertical axis extending from both midpupil and lateral canthus to the caudal row of brow hairs with eyes at neutral gaze and the head at Frankfort plane. Preintervention and postintervention brow height was measured by the primary clinical investigator. The average brow elevation from the midpupil observed after selected injection of brow depressors with botulinum toxin A was 1.02 mm (p = 0.038). The average brow elevation from the lateral canthus observed after selected injection of brow depressors with botulinum toxin A was 4.83 mm (p<0.0001). Significant temporal brow elevation occurs as the result of paralysis of brow depressors by using botulinum toxin A injection. This procedure may be considered an alternative to surgical brow elevation.

22 Neuromodulators in Facial Aesthetics

“…While the primary focus of BoNT therapy to the orbicularis oculi is for the treatment of crow's feet, the orbicularis oculi is also the most powerful depressor of the brow and can contribute greatly to reshaping the brow and upper face through neuromodulation. 17,18 Thus, aesthetic treatment of the lateral orbital region should involve consideration of the hyperdynamic lines and brow reshaping. Although single-point limited dosing at the lateral brow margin may provide some benefit in elevating brow position, it is important to keep in mind that the entire lateral orbicularis oculi is responsible for brow depression and, as shown in the senior author's previous work, 17,18 treatment of this large and powerful depressor can have a profound impact on brow position.…”

A Review of Facial Anatomy as It Relates to the Use of Botulinum Toxin

“…1 Conversely, selective inactivation of the brow depressors without treating the frontalis can result in brow elevation, used by some clinicians to induce a ''chemical brow lift.'' 10,11 Orbicularis Oculi…”

Regarding Digital Cameras

“…They applied in a serial manner 7-10 U of the toxin below the lateral brow, into the superolateral portion of the orbicularis oculi muscle. 5 We use the Huang et al technique to treat three female patients (mean age 42 years). At the glabellar point, the same dilution (2 ml saline solution per Botox vial) and the same dose (5 U) was used.…”