How Do You Fix the Cresent Shaped Rhytides Above the Lateral Brow?

Dear cal5, The lateral crescents which may look like the "quizzical look" or the "Jack Nicholson look" can be seen when the 11's are treated centrally and the lateral brow area is not. This can be corrected with judicious placement of Botox in that lateral area. One must be careful when doing this to prevent lateral brow drooping. Botox is a wonderful treatment option for properly selected patients. Good luck. Dr. G.

Most likely the lateral brow/forehead has fallen with time and the person is trying to lift the brow, by using the forehead muscle. When the muscle contracts, it causes the creases. The treatment is likely lateral brow/forehead lift.

When a patient is being evaluated during a Botox treatment, I watch their expressions during our conversation. If I see a patient that at baseline uses their lateral eyebrows a lot, I know they are at risk of developing a little rhytides over the lat brow. Depending on their eyebrow position, I will usually inject a small amount of Botox over the lateral brow at the same time that I inject their glabella. It is a balancing act, as the other physician's have noted because if you over inject the lateral eyebrow, the brow can flatten or droop and that would be undesirable. I document the height above the lateral brow where I inject so that at future appointments, I am able to maintain brow position and avoid the crescent shaped rhtyides that you are referring to.

Cal5Your friend needs individual attention by someone who understands the dynamics of the facial muscles. The lateral (outside) muscle fibers of the frontalis (forehead) muscle are compensating for the central weakness caused by the treatment of the 11's and likely some of the central frontalis which can give a "quizzical" look.This can be improved if done carefully not to trade it for a sunken brow.Best,Dr. Malouf

It is common to see an exaggeration of frontalis muscles when only the procerus (11's) have been treated. In some one who claims never to have had Botox but shows deep wrinkles of the forehead with active elevation of brow, this can be improved with neuromodulator treatment such as Botox. There are no pictures or ages to assess to provide you with a more specific response.

The lower lateral brow is often left alone and not treated so that a patient can still have some motion and does not experience brow ptosis. This can show up as the lines you are describing.

The lines above the eyebrows are caused by function of the frontalis muscle. This muscle elevates the brow. Over function of the muscle can be controlled by Botox which can flatten these lines. However, if the brow has fallen and needs elevation, blocking the frontalis will drop it. If this is the case, a brow lift is necessary to flatten the lines.