What is the ideal injection spot for getting an outer eyebrow lift using Botox?

Question

What's the most common injection spot that will cause droppy eyelids? And how many units are reccommended in order to avoid any bad results? I'm scared about possible eye droopy-ness after a botox brow lift. Thank you in advance for your answers!

Young R. Cho, MD, PhD · Answer

Thank you for your question. Botox will need to be careful he injected into the muscles that pull your bro downwards. A physical exam would also help determine whether you're a candidate for this procedure or not, or if you have a risk of developing ptosis (if there is too much brow ptosis or lid laxity).

Richard G. Schwartz, MD · Answer

For raising the outer third of the eyebrow, your doctor can inject 1-2 units just below that portion of the brow.  This will relax the muscle that tends to pull the brow downward, and therebye allow the frontalis muscle on the forehead to hold the brow higher.  On the other hand, when treating horizontal forehead wrinkles with botox, we want to relax the frontalis muscle across the whole forehead.  If the botox is injected too low, just above the brows, then that low portion of the forehead muscle will relax and will not hold the brow up in its normal position.  So the brows will droop.  To avoid drooping brows, the botox must not be injected too low or too close to the brows.

Alim R. Devani, MD, FRCPC · Answer

Thanks for your question. This is a question that we
get asked often by our patients. These are advanced techniques so be sure to get an
experienced cosmetic dermatologist consultation for recommendations and
treatment options.

William Marshall Guy, MD · Answer

Hello anaradova,In order to raise the brow your injector is trying to immobilize the muscle that pulls down the outer eyebrow.  I usually use 1-2 units at the first injection placed below the outer part of the eyebrow.  Your actual treatment should be discussed with your injector as well as the results that can be expected.  There is always a risk of having a droopy eyelid but by keeping the units very low it limits this risk (but cannot completely eliminate it although I have yet to drop an eyelid or eyebrow with this conservative approach).  I hope this helps and good luck.

Darryl J. Blinski, MD · Answer

Always best to see a Botox injecting doctor to advise. But the area to achieve brow lift is below the lateral eyebrow using a few units of notice at most.

Edwin Ishoo, MD · Answer

Please find an experienced doctor for your treatment and you won't need to worry or know where the "ideal injection spot" should be.

Gordon Searles, MD · Answer

The main reason for the dropping of the eyelid is the placement of the Botox being too close to the orbit margin. If the injection point is too close to the edge of the orbit, the medication will drift into the upper eyelid and relax the muscle. The degree of dropping is more if the concentration is higher. If this occurs, the a minor drop can be corrected with the use of eyedrops. Otherwise, you'll have to wait for the Botox to wear off.The number of units of Botox used is less important than the concentration of the Botox solution. Some injectors use high concentrations which means small volumes. Other injectors prefer to use  low concentrations which means a larger amount of fluid injected into the brow. So, if a large amount of fluid is injected into the brow, this fluid can spread through the muscles and perhaps move into the upper eyelid. Also, the number of units of Botox required depends on the degree of muscle strength. The stronger the muscle, the more units required to get the result.Experienced injectors follow a rule where you can always add more Botox, but you cannot take it away. Having injections done by someone with lots of experience may not guarantee that there will be no eyelid drop, but it can ensure that it is much less likely that it will occur.

Reza Momeni, MD, FACS · Answer

Experienced injectors will often use a combination of corrugator muscle injection and upper outer orbicularis oculi injection to achieve a high arch.  This is not for beginner injectors.  Please make sure you see a properly trained and experienced PS for this.

What is the ideal injection spot for getting an outer eyebrow lift using Botox?

Answers (8)

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