How do you lift the brow with Botox?
This is a common request I receive from patients and is something not all injectors know how to assess properly. I want to outline proper assessment of brow position and how to avoid the much feared brow drop – for injectors and patients alike. If you are interested in scheduling a consultation for a treatment, check out our Botox page or fill out the form below.
Step 1 – Assessment
Whoever is performing your injections should be assessing your brow position with your eyes closed! This is the most important part of the initial Botox/Dysport consultation. If they are not doing this, your chances of having a dropped brow are significantly higher. People naturally lift their brows when their eyes are open. Only when we close our eyes and really relax our forehead can the true brow position be assessed.
If your brow position sits below the rim of the eye socket with your eyes closed, Botox/Dysport should be used very conservatively in the frontalis muscle to prevent brow drop.
Step 2 – Anatomy
Botox works by weakening muscles. If you weaken the upper forehead (frontalis) muscles, you will not get a brow lift, your brow will drop. The injector actually must weaken the muscles that pull down the brow. These muscles are the muscles BETWEEN the eyebrows (the 11’s, corrugator and procerus muscles) and along the OUTSIDE OF THE EYES (crows feet, orbicularis oculi). This allows decreased pulling of the eyebrows downwards and allows the frontalis muscle to lift the brow.
Step 3 – The Final Result
When the frontalis muscle is able to lift the brow, there is still upper forehead movement and wrinkles present, but the brow is now in a higher position. Again, this is the common misconception and something I educate my patients about. If you eliminate all horizontal forehead wrinkles then you will be dropping your brow down to the natural position of your brow (where it is with your eyes closed and your forehead relaxed).
Step 4 – Less is sometimes more
If you can understand these concepts, then you are steps ahead of many people that receive Botox/Dysport as well as many injectors! As my patients get older, I actually use less Botox in order to preserve a higher brow position.
Step 5 – Find someone you trust
If all this sounds rather confusing, then don’t worry! Find someone experienced that you trust to perform your injections. Preferably someone with a strong background and understanding of the facial anatomy and how it functions.
Lastly, are there surgical options to correct a low brow?
For patients with a low brow, the best correction that can both raise the brow and eliminate forehead wrinkles is a Browlift. This can be done through an endoscopic approach in most cases. Endoscopic browlifts are done through small incisions in the hairline and have minimal downtime. Most swelling and bruising is gone within 1-2 weeks.
Any questions or thoughts? Don’t hesitate to email me: jordan@rihanimd.com
Dr. Jordan Rihani is a double board certified facial plastic surgeon who specializes exclusively in cosmetic and reconstructive surgery of the face including facelift, rhinoplasty, eyelid lifts, botox, and fillers. He is a national trainer on injectables as well as a Clinical Assistant professor at UT Southwestern Medical Center.
