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Counteracting Ptosis with Simultaneous Forehead and Eyebrow Botox Injections?

asked 3 years ago by huntress in Pennsylvania, USA
Latest answer by Jessica J. Krant, MD, MPH
Question viewed 9,621 times
Tags: ptosis

I had Botox in the horizontal forehead lines. Even though my plastic surgeon limited the injections to the upper part of forehead (I wanted him to go lower, but he said no it might drop the brows too much), the brows dropped a bit anyway. My question is this: when I have the horizontal forehead lines done again, can I ask him to do a simultaneous Botox brow lift to counteract the brow ptosis from the Botox in the horizontal lines?

12 answers to Counteracting Ptosis with Simultaneous Forehead and Eyebrow Botox Injections?

A fine balance

Well put by all panel members. There is definitely an art and technique to bring a balance in finding the correct dosing to meet both goals. Patient education is a must when helping one understand how to reach their goals. Take the time to find a practitioner that accomplishes both.

Harold J. Kaplan, MD
Los Angeles Facial Plastic Surgeon

www.celibre.com

Botox Brow Lift is possible

Huntress The short answer is yes. This is a technique that a good plastic surgeon uses all the time. The frontalis and obicularis oculi muscles are "antagonistic muscle pairs" for eyebrow position - when one contracts the other relaxes - changing the eyebrow position. The skill part of injecting botox is understanding the anatomy of the antagonistic muscle pairs in the face and injecting the right amount of botox in the right places to control the position of the eyebrows. ... more

Daniel Reichner, MD
Newport Beach Plastic Surgeon

Bingo!

Huntress, You have identified the fine balance that defines the facial musculature. Just as your bicep and tricep muscles act antagonistically (against each other), so too do your brow raising and depressing muscles. So, if you also paralyze your brow depressors at the same time you paralyze your brow elevators, you may be able to avoid the brow dropping or ptosis. The next time you go in for a treatment tell your plastic surgeon about the brow ptosis and ask if he can treat your... more

Kenneth R. Francis, MD
Manhattan Plastic Surgeon

The Art of Balancing Botox

Botox placement and dosage is definitely an art. Even though your plastic surgeon only placed the Botox in the upper forehead, you still felt heaviness on your brow. Optimal Botox is not only goverened by location, but also by amounts used. Too much Botox in the forehead, even high up, can still produce undesired effects. Balancing the actions of opposing muscles (Botox brow lift with forehead line softening) is definitely an art and takes practice. It is worth pursuing. As you did,... more

Jessica J. Krant, MD, MPH
Manhattan Dermatologic Surgeon

www.ArtofDermatology.com

Botox and lines

You certainly can have Botox injected in the lateral aspects of the eyebrow itself to help elevate the eyebrow. However, there is a slightly increased risk of causing eyelid ptosis. The Botox can migrate a bit and when injecting the area of the eyebrow it can seep into the orbicularis

Steven Wallach, MD
Manhattan Plastic Surgeon

Very common to treat lower forehead with Botox

Yes, it is very common to treat the lower forehead (the area between the eyebrows) with Botox to decrease the pulling-down effect of these muscles when treating the upper forehead to minimize the drooping that does occasionally occur.

Ronald Shelton, MD
Manhattan Dermatologist

Yes, brow elevation with Botox can be done

Thank you for your question. Getting brow elevation, or preventing/counteracting brow ptosis, can sometimes be an art. To accomplish this, simply speaking, I would inject Botox into the central areas of the forehead and avoid the outer areas. In addition, I may choose to do the area between the eyebrows and a spot underneath the outer eyebrow. If you do the entire forehead, then yes, your physician may actually cause a brow ptosis if he injects too low. Try asking to see if your physician... more

Don Mehrabi, MD
Beverly Hills Dermatologist

Brow elevation with Botox is possible

Hi Huntress, Yes, by treating the depressor muscles of the brow (the corrugators and procerus), the brows should lift a bit. The injections in the forehead (frontalis) muscle should be minimal to avoid that completely frozen look of Marcia Cross or Nicole Kidman. Good luck and be well. Dr. P

Michael A. Persky, MD
Los Angeles Facial Plastic Surgeon

Botox in the forehead weakens the brow lifting muscles

Dear Huntress It is impossible to make forehead go up and down at the same time. Where the eyebrow sits is a tug of war between the frontalis, the lifter muscle in the forehead, and the orbicularis oculi muscle just below the eyebrow and extending into the crowsfeet area, and the muscles at the top of the nose that squeeze the brows together. Increasing lines in the forehead are an indication that the forehead is fighting the pull of the eyebrow depressors. We do this for a variety of... more

Kenneth D. Steinsapir, MD
Los Angeles Oculoplastic Surgeon

The vertical lines between the eyebrows should be injected at the same time.

The horizontal lines on the forehead are produced by the forehead muscles contracting. These muscles lift the brow in an upward direction. When Botox weakens the forehead muscles, the muscles between the brows, called the procerus and corrugators, will have an unopposed downward pull on the forehead. So you should definitely have these muscles injected at the same time. That will keep the brows from drooping and give you a nice natural improvement in brow position and wrinkles. Good... more

Andrew Miller, MD
Edison Facial Plastic Surgeon

www.associatesinplasticsurgery.com

You can raise the brows with Botox

To huntress, Hi! This is one of the most successful uses of Botox: the "chemical brow lift". The position of the brows is set by a BALANCE OF MUSCLES. Some muscles pull the brows up and some down. I use 30 to 40 units injected into anatomical points on the inside and outside of the brows. The botox here relaxes the muscles that pull the brows down. The muscles that raise the brows then act unopposed and the brows come up a couple of millimeters.

George J. Beraka, MD
Manhattan Plastic Surgeon

In short, yes

The botox brow lift, which involves injection of Botox just beneath the brow near the tail and just below the head of the brow, near the nose will somewhat counteract the relaxation of the forehead muscles. Care must be taken, however, not to inject too close to the eyelids which can cause dooping of the eyelids (ptosis).