How Low Should Botox Be Injected in my Forehead?

Short answer -- you should try to inject at least 1-2cm above the brow to reduce the likelihood of brow drooping.  Note however, that I said to "reduce the likelihood" and did not say to "prevent" brow drooping.  Reason being, with someone with low-set brows, or those of increasing age, one is more likely to develop a brow droop as their brow raising muscle, the Frontalis, is paralyzed with the Botox.It all depends on the examination by your physician injector.  He/she would carefully examine you to assess, at the very least, your brow position, the location of your forehead wrinkles, and the vector of pull of your Frontalis muscle.  Over-treating some areas can give you a brow droop, while under-treating some areas can give you a "Spock-like" or "Klingon" result -- whichever Star Trek reference you prefer :)  These are just a few of the complications that can happen...My overall recommendations are to seek the services of an experienced physician injector. I think the key with Botox lies in truly understanding the anatomy of the injected area, and more importantly the variability in the anatomy between patients -- for brows, the forehead, and anywhere else you plan on receiving a Botox injection. This includes having a firm understanding of the origin, insertion, and action of each muscle that will be injected, the thickness of each muscle targeted, how deep beneath the skin the actual muscle resides, and the patient variability therein. As an aesthetic-trained plastic surgeon, I am intrinsically biased since I operate in the area for browlifts and facelifts, and have a unique perspective to the muscle anatomy since I commonly dissect under the skin, see the actual muscles themselves, and learn "first-hand" the incredible variability between patients -- live, "on the OR table" -- as opposed to via lectures or a cadaver dissection. For me, this helps guide where to inject and where not to. However, with that said, I know many non-aesthetic trained plastic surgeons and other physicians who know the anatomy well despite not operating in that area, and get good results.Good luck.Dr Markarian

Unfortunately, as we age, our forehead droops and we use the forehead muscle actively and subconsciously, to contract and pull up the eyebrows and eyelids with them.  This causes more mid forehead horizontal lines. If we were to treat those lines with Botox, then the forehead muscle would relax and not be able to keep up the eyebrow/eyelid complex and the drooping of the lower forehead would be inevitable. Even if the person has had botox done for years without problems, they may find as they reach the early to late 40s that their botox regimen will have to be different to accomodate the aging effect of the forehead.

If a doctor were to try to give very few units in the mid forehead, it probably wouldn't help reduce the lines signficantly and it would still run the risk of dropping the eyebrows.

Occasionally fillers can help smoothen this area but swelling and bruising temporarily (more than a week) could be a factor and there is a risk of lumpiness and even some filler moving by gravity or expressive muscular force to a lower area on the forehead depending on the technique used to inject the filler (volume, placement at which depth, rate and force of injection, etc.).

Many patients eventually realize they can only continue having botox injecitons in the glabella between the eyebrows and no longer can treat their forehead.

My 2 cents in this case is as follows:  Horizontal lines in the forehead are most commonly caused by subconscious activation of the frontalis muscle, which is the muscle that elevates the brow.  People with heavy brows tend to do this without knowing it.  The key to addressing this is to inject the "fronwner muscles" between the eyebrows, staying low over the brows.  Also, the orbicularis muscle, the one that closes the eye is injected just above the brows (in minute amounts), and also in the crow's feet.  This allows the brow to elevate and takes away the subconscious need to hold the brows up with the frontalis.  If there are still horizontal lines, very small amounts (usually diluted) of Botox can be added to the frontalis itself. 

The question you ask is a very good one. It is important to receive your injections (Botox or fillers) by a physician who specializes in the treatment of the face. This is the most important, and understated, element of a successful result. Indicators that help are: Specialization in the face, certification by an accredited American board, fellowship training, strong community reputation, fellowship training and even academic affiliation.

 

Be healthy and be well,

James M. Ridgway, MD, FACS

Hi Jen,You need to see an experienced injector. If you're in BC, I'd recommend the offices of Peter Lennox, Kevin Bush, Alex Seal, or Rob Thompson just off the top of my head. There are many fantastic injectors in BC.Best,