How to avoid brow heaviness with forehead anti-wrinkle injections
– Hello my cosmetic friends out there. I’ve got a question from our Facebook page from Michelle Hart. She asks us, how do you have Botox on your forehead, but not feel heavy in the eyebrows or eyelids? Firstly, this is a common problem we have on a daily basis here.
A problem because the forehead muscle, called the frontalis, actually elevates the eyebrows and the eyelids and this is the only elevator of the eyebrows and the eyelids. There’s nothing else which elevates it.
No other muscle in the face, just one muscle called the frontalis. It’s got two bellies which attach to just under the brow and they lift up, lifts up your forehead. Yes, it’s a good thing to lift up your forehead.
The problem with this is that when you lift up your forehead you get wrinkles. People hate having wrinkles in their forehead. It gives them a worried appearance. It’s something that people wanna get rid of.
Botox is often used in the forehead to stop elevation of the eyebrows and eyelids. So, what actually happens is that it flattens the whole forehead and wrinkles become less. But, as a result of the frontalis muscle, the forehead muscle, being the only elevator of the brows, what people often find is that it gives you a bit of a drop.
Clinicians have to make a compromise with how much Botox we put in the forehead because too much Botox in the forehead could cause heaviness in the eyebrows and too little can cause too much movement or wrinkling of the forehead.
So, the first thing I often do with my patients is assess how their brow position is. So, like for myself, I’ve got a lotta skin there which is sort of genetic in my case and if I have even a small amount of Botox in my forehead it really does give me a heavy feeling and I really don’t like that.
Those people with forehead lines or a lot of movement in their forehead, they’ll really wanna treat it. So, how do we come to some sort of balance and compromise? First thing is working out the dose. So, generally we start low with the dosage.
It might be, you might start at say, half a normal dose if someone has heavy eyelids. After assessing the eyelids put in a small dose and that can help. It doesn’t always get rid of the forehead lines completely, all of the movement completely, but sometimes that’s not a bad thing.
Looking natural can be a good thing. The other thing that I often see, which I don’t agree with is that practitioners will inject just the center part of the forehead. So, basically, the Botox will hold the center part of the forehead still and the outer parts of the forehead will still raise.
So, you get this what I call Dr. Spock look. So, you get this elevation like this because we just paralyze the center part of the forehead, but the outer parts of the forehead we’ve left. Look, it does help with the compromise between the heaviness and the reducing wrinkles, but what the end result is that you get this, I think it looks terribly unnatural and it doesn’t look, and it’s a giveaway that you’ve had Botox done.
So, you get this elevation of the eyebrow at the end, at the tails of the eyebrow and also you get wrinkles just above there. So, you get a wrinkle just above your lateral tail of the eyebrow and that look unusual.
And, generally speaking, you know, the brows are not meant to be super arched like that. Look at a young girl, for example. Her brows are generally full and fairly low. They’re not arched like this. Actually, in fact, as we get older sometimes our brain tells us to lift our eyebrows higher and higher and higher.
So, as we get older our brows tend to get higher, ironically, one of the few parts of the face which goes up with time. People generally come in, I would say probably nine out of 10 women who come in, ask me for an eyebrow lift.
Now, once again, this is not necessarily something that looks good and not necessarily something that looks youthful. So, as we age sometimes remember, our brows go up to compensate for excessive eyelid skin, so our brain tells us to lift our eyelids up, eyebrows up.
So, aesthetically, a fairly low, flat brow which is full is the most aesthetically pleasing. It can go a bit beyond that where you have excessive skin here, as well. Now, in that case what needs to be done usually is a surgical blepharoplasty.
So, if you’re finding that you have too much skin here and that’s and you’re wanting to compensate by using Botox or some other method to give you a brow lift, it’s probably best that you go and get a little bit of skin excised from your upper eyelid.
You don’t need to lift the brows up like this so that your eyelids look lighter. It’s sometimes necessary to have surgery in this case. Usually we assess this by looking at where the eyelid sits and if your eyelid sits on your eye lashes, so the eyelid is sitting on the eye lashes, then you are a candidate for surgical blepharoplasty or eyelid reduction.
One other little trick we can do which doesn’t give you the Dr. Spock or you know, that super arched eyebrows and that is to put a little bit of Botox in the depressor of the brow, which is the orbicularis muscle.
So, this is a sphincter muscle which basically shuts the eyes and pulls the brows down, like this. See, you see my brow is dropping. So, what I can do is put a little bit of Botox in here and here with the forehead Botox.
So, I’m stopping the pulling down force of the orbicularis oculi muscle, which is just there. So, putting a drop of Botox in there when we do forehead Botox is also very, very effective in helping reduce the depressing effect of forehead Botox.
The irony of all this is also this, people who have more forehead lines or have resting muscle tension, that is, when they’re even not trying to raise their forehead, they’re raising their forehead and they’ve got wrinkles all the time.
These are the hardest people to treat and probably the most likely people to come in for a treatment like Botox. So, this is the irony behind that. The more heavy we get in the upper eyelid the more our brain tells us to elevate our brows and activate that frontalis muscle.
So, what ends up happening is that you get stuck, it gets stuck there, literally. So, you get hyper tenacity or sort of could cause an activation of that frontalis muscle, the forehead muscle. So, it sticks there and as a result, your muscle tension is always on.
Your muscle’s always on, and as a result you get forehead lines which are permanently etched in. Now, these people actually make very poor candidates for having Botox, ’cause as soon as you touch them with any Botox, they’re gonna feel awfully, awfully heavy.
So, this is the irony. People with the most forehead wrinkles are often the least suited to Botox treatments on the forehead. So, how can we overcome this problem? So, how do we treat the forehead lines without causing too much drop of the brow? Well, this could be the answer for a lot of you out there and the answer is dermal fillers.
So, interestingly, what you can do is treat the forehead with dermal fillers instead of Botox. So, often as we get older our face loses volume, so we shrink and shrivel, especially if you exercise or if you’re very lean or fit.
And, what happens is you get a concavity just above your brow. So, a bit of a concavity there, and this is quite, some people see it quite a lot. So, the forehead generally loses a lot of volume and if you think about it, losing volume in the forehead is like taking a beach ball and taking a little bit of air out of it.
It’s gonna sag and sink. So, with loss of forehead volume, you do get a little bit of brow droop, okay. So, putting the volume back in the forehead is a very effective means of lifting or repositioning the brow.
So, I think dermal fillers in the forehead is effective because it replaces volume, which lifts the brow a little bit and importantly as well, it also helps to efface or reduce forehead wrinkles because you’re adding volume to an area which is shrunken, so if something’s shrunk then it will naturally wrinkle more.
The other thing you can do with dermal fillers is then use them to fill the lines, very superficially. So, you can use a finer dermal filler for example in the skin, not deep like I was explaining before to revolumize, but just a derma filler in the skin, in through those lines and that will also give you a very, very nice smooth appearance to the forehead.
So, in summary, the question to, how do we do Botox on the forehead without giving you a heavy brow or heavy eyelid, is by looking at the dosage, looking at reducing the activity of opposing muscles, orbicularis oculi, which pulls down, so knocking that out a bit, looking a using fillers to revolumize the face, or revolumize the forehead as well as to fill in fine lines, and also to look sometimes at having a little bit of surgery just to take out the excess skin in the upper eyelid prior to having any Botox.
So, I hope that’s helped answer the question. I look forward to answering your questions in the future.