Before treatment, we must first identify the muscle balance in the forehead and the periorbital region. The frontalis muscle is the only muscle that elevates the eyebrows; the orbicularis oculi, procerus and corrugator all work to pull the eyebrows down. So, if we relax these muscles, the frontalis can work unopposed and hence an eyebrow lift is achieved. In older patients, we also often see frontalis over compromise – they are constantly lifting their eyebrows so that their vision is not affected. In these patients, we must be careful with the use of botulinum toxin in the forehead as that would worsen the condition.
Normally, 2-4 units of botulinum toxin in the tail end of the eyebrow is sufficient for a lift. The injection point is indicated by the dot in the diagram and this is usually 1-1.5cm from the lateral canthus. Sometimes, treatment in the glabella may be required too. An important thing to note is that if the client also wants botulinum toxin in the forehead, the injections must be made higher up and closer to the hairline so that the inferior fibres of frontalis can remain active.