Can pressing just below the injection site prevent Botox from migrating below the brow bone?

I have had Botox treatments several times. This time however the Dr. instructed me to put light pressure just below the brow bone or just on the orbital ridge to prevent the Botox from migrating into the eye area causing a drooping of the lid and brow. Everything I read says that you should not put any pressure on the site. My question is... Will pressure applied just below the injection site keep the Botox placement high in the muscle preventing it from migrating into the eye area?

Doctor Answers 3

Botox Migration

Botox is a fabulous tool for injecting wrinkles.  Proper technique is the most important part of preventing diffusion or migration of Botox.  There are no studies that I have seen in putting pressure against the orbital rim after injecting Botox.  For the best results it is most important to find an experienced board certified dermatologist.

Botox migration

As I am injecting Botox into the corrugator muscles above the orbital rim, I place my thumb firmly against the upper medial orbital rim, and immediately after injecting I ask my patient to frown forcefully against my thumb. The small amount of fluid containing the Botox molecules will diffuse in the lateral, medial, and superior planes, but should be less likely to travel inferiorly under where my thumb is pressing. Then, and later as the patient contracts their muscles as they make expressions after the treatment, it may not be as likely to diffuse downward, where one might not want it to go.  

I have not seen any cases of migration-related eyelid or eyebrow droop in my patients treated in this fashion, as it has allowed me to place highly-concentrated Botox in small volumes exactly in the bulk of the muscles I want to relax, immediately above the orbital rim, while sparing the muscles I want to avoid treating.  I do not place the Botox one or two cm above the orbital rim because the frontalis muscle is then relaxed as well and patients, while having some smoothing of the frown lines, also have this strange depression of the medial brow and a lift of the lateral brow that is a true Spock-like "tell" that one has had a (not great) Botox treatment. When placed closer to the orbital rim, the brow then lifts 1 to 2 mm rather than drooping.

It only takes 60 to 90 minutes for the Botox molecules to attach to the motor end plates of the nerve endings in the muscles, however, so by the time you are home it should no longer make a difference whether you do or do not apply pressure anywhere. Your doctor should be doing this for you.

I hope this helps to answer your questions!

Sheryl D. Clark, MD
New York Dermatologist
5.0 out of 5 stars 7 reviews

Skin pressure and Botox migration

I am not aware of a study that has shown that pressure on the skin will prevent Botox from diffusing in that direction. It may not do any harm to press below the orbital rim but I doubt that it will prevent diffusion effectively. 

Niels C. Krejci, MD
Boston Dermatologist

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.