How to have frown and forehead anti-wrinkle injections without looking like Mr Spock!
– Hello my cosmetic friends out there. We are going to do another video today on a common problem I see with botoxing the frown and that is looking like Dr. Spock. How do you have botox without looking like Dr.
Spock? It’s a common see I see out there in the community and I must admit I am guilty also of giving the Dr. Spock look to a few of my patients so I’ve learned the hard way how not to do it. But certainly I see a lot of people who come to see me and they’ve been botoxed elsewhere and their brows arch up heavily on the outside giving them a very unnatural appearance.
We will go through how we can prevent this for you as a patient so that you don’t look unnatural and you don’t look botoxed because this look here is probably the biggest give away that you had botox.
And what is the hallmark of a bad cosmetic treatment? It is when people can tell that you’ve had it done. Anything that gives away the fact that you have had a cosmetic treatment other than you look really refreshed and well and attractive.
Anything other than that and basically you’ve gone down the wrong path. First thing we will go through the anatomy of the muscles in the frown and forehead area. So firstly the frown. Our frown consists of two main muscles.
The corrugator muscle which pulls in this way. Gives you the legs 11 or vertical frown lines. Then the procerus muscle which attaches here and goes towards the nose and pulls in this way and gives you horizontal line across the nose.
And together when you frown you get a scrunching of that area in towards the center. So you get vertical lines from the corrugator muscle and a horizontal line from the procerus muscle. Often we inject about five points in this muscle to help to relax the muscle and that relaxes both those muscles.
The procerus muscle from injecting the center and then the corrugator muscles from injecting just by the side of the procerus muscle. The other muscle we deal with this in this area is the frontalis muscle.
This muscle starts at the brows and ends in the scalp. And allows our forehead to move up and our brows to move up. This is an elevator of the eyebrows, the only elevator of the eyebrows that we have.
Often this muscle is relaxed to stop the formation of wrinkles in the forehead. Also, we have an antagonist to this muscle up here. Which is a muscle here, just above the eyes, and you can see this pushes, this muscle here pushes down that way and pushes my eyebrows downwards.
This muscle here is called the obicularis oculi muscle. So that the antagonist to the frontalis muscle which elevates, so these are opposing teams of tug of war. It seems simple, right? But why are there so many issues with this area? Why is it that I constantly see people that come in with the Dr.
Spock look? I think one of the underlying reasons is the way that most botox practitioners are taught from day one. I recall myself learning this back over 12 years ago now. The very first thing they teach you is a mistake.
They actually teach you the wrong thing from the beginning and I still see it. The same teaching is going on today. In some workshop somewhere, with some new injector is learning about botox for the first time and they are teaching them wrong from the outset.
This is the rule they teach you: When injecting the frontalis muscle inject everywhere you like except a centimeter over the outer brows. Don’t inject that area. So basically people inject all, the whole frontalis muscle and what happens is this little bit of muscle remains active.
Whereas the rest, you know you get some relaxation of muscles and this whole section is not moving except for this little bit just above the brow. Now of course what’s going to happen you can guess, is that it will elevate the lateral ends of the brow.
Like this. So if you botox the whole forehead and not that little bit above the brow on the lateral parts of the brow you are gonna get compensation of that part of the muscle and it’s gonna become stronger to actually elevate the lateral brow even more.
That is probably one of the primary errors when it comes to injecting botox which is injecting and leaving that area out. And the reason they say not to do this is because there is fear that if that area is injected possibly the brow will drop.
Because remember, the frontalis muscle is the only muscle which elevates the forehead. The fear is if you inject just above there in the frontalis muscle, that’s gonna cause a drop of the brow and the patient will complain of heavier eyelids and heavy brows.
But you know what, that’s not the case. It’s not true at all. What determines whether you get a brow drop or not will primarily be due to preexisting anatomy or preexisting genetics where someone has a heavy brow and heavy eyelids so they are more predisposed to it.
Or the total dose of the botox juice, that is a bigger determinate than anything else in terms of whether someone will feel heavy or look heavy after they have had botox to the forehead. So that area, when avoided, will give the patient a false impression of eyebrow elevation.
It actually just makes them look really weird. The key here, the first thing to do, is to avoid injecting just the central parts of the forehead because what will happen is the lateral parts will compensate and keep up.
Now the other thing that often happens is when the frown is injected. See the frown is just a strip of muscle, the corrugated muscle is a strip of muscle just above the eyebrow. When the frown is injected too high, that is instead of injecting in the frown, the practitioner injects just above the frown or a little bit too high and what happens is instead of it going in the frown muscle the botox goes into the frontalis muscle so it diffuses upwards into the frontalis muscle.
So what happens is that the muscle is kept still. The frontalis muscle is held still in the center and then, of course, the lateral one, the lateral part of the muscle compensates by shooting up. Here’s a little test you can do yourself to see if you are likely to get this Dr.
Spock effect and you can do it with three fingers. You might want to test this before you go have botox with your doctor. The way you do this is just hold the central part of your forehead down and raise your eyebrows.
See if you get this elevation like this. You see? So if I botoxed my frown and the middle part of my frontalis muscle I would get Dr. Spock. When I do that normally, it’s fine. In my case, if I was to have botox, I would need to have it right across the forehead and not just in the central part.
That would be the litmus test, I guess, to see whether you are a likely candidate for getting the Dr. Spock if you only botox the central part of your forehead and not the outer brow. With our first patient, it’s Amelia.
You might have seen her before in other videos. She is one of our staff members here so we pull her into all of the videos. Okay, so let’s get, let’s have a look at her muscles. Give us a frown. You see the corrugator muscle goes from here to here and from here to here.
That pulls in her frown and her vertical lines. Okay, relax. Now frown again. The is the procerus muscle that goes from here to here. Pulls in this way and provides that horizontal line. You’ve got very good skin and you see at rest there are no lines.
Some patients may have lines even at rest. We are gonna look now at her forehead. (laughing) To treat her forehead, it’s quite tall – It’s quite tall. It’s quite high forehead. – It’s quite a high forehead.
I actually like it personally, she doesn’t like it. The forehead muscle or the frontalis muscle attaches here and attaches into the scalp and in the brows. So basically, it, raise your eyebrows. Raise.
It causes elevation of the eyebrows and eyelids. (giggles) In order to assist how much you can put in there you have to just make sure the patient doesn’t have heavy brows. Now Amelia is fairly young.
She’s got good skin there, no loss of elasticity. If she had heavy brows like this or heavy eyelids we’d reconsider how much we’d put in her forehead. Let’s go as to what I talked before, is often practitioners are taught in their first day of injecting, never to inject around here because this will cause brow droop.
This won’t cause brow droop, basically. Injecting there is an absolute necessity. When I’m injecting botox into the forehead, I always inject this bit above the brow, always. Otherwise, this muscle becomes hyperactive.
You inject everywhere else and this muscle overcompensates and becomes hyperactive and then you get this unusual elevation of the eyebrow. If, for example. If, for example, Amelia was injected in these dots up here and these areas were left, what would happen is these muscles would overcompensate and elevate the brow and these muscles here would cause the brow to drop so you get the center of brow medially and lateral elevation.
Which looks a bit like a cartoon character to me. – Yeah, like. – Yeah. Ironically as well, as we get older our brows tend to get higher and higher and higher. If you look at some older people, sometimes their brows are almost half way up their forehead because they are trying to compensate for excessive eyelid skin here.
Which, their brain then tells them to elevate their brows to actually get their eyelids out of the way. What happens is their eyebrows get stuck up there. In fact, if you elevate the brow, you are actually emulating an older person.
You actually don’t want to do that. The other concern often is that when people get botox here. Frown for me. We knock out this muscle here. This is where the injections are supposed to go, around here.
But sometimes people, practitioners may inject, instead of injecting there, the inject up here. What happens instead of hitting this muscle here which is the muscle that you want to inject they end up hitting again, the frontalis muscle, which elevates the eyebrows up.
If this injection diffuses into this muscle here, it will press down on that part there, which will again, will make the brow compensate by pulling up there. You can be very careful where you inject your corrugator.
Not too high. And then the final mistake, just to top it all off, to put the icing on the cake, is put botox in this spot around here to actually reduce the downwards pull of that muscle. That muscle normally pulls down and you knock it out with botox here.
But when you do that, you get even more elevation of the brow. What happens is that people leave this area here unbotoxed, they botox this area, so in other words, basically the tug of war goes in this direction.
This muscle is left to be strong, this muscle is made to be weak, and where does a brow go? It goes up on the lateral part. Again, a very unusual appearance. Those marks look pretty unusual, too. Let’s actually do it properly for you.
– Okay. – So now we are gonna inject her face properly with botox. – [Amelia] What? – And show you how it’s going to be done. I’m just gonna clean all of the marks up for you. I remember a time, actually, when I injected a man.
A very, sort of successful CEO of a company. He actually, I actually made the classic mistake of injecting him in the middle of his forehead and not so much on the outer parts of the forehead as well as injecting the frown and giving him brow lift.
He looked so weird that he couldn’t go see his own mom. When he went to see his mom, he had to focus on actually not elevating his eyebrows. Otherwise, he just looked like. I mean it’s worse on a man then on a woman.
Brow lift doesn’t look good, arching doesn’t look good on a woman but it looks even worse on a man. – [Amelia] That’s so funny. – Yeah. So basically, I learned my lesson after that. That was a long time ago.
We will just go through our usual treatment regime with botox and first thing is just to mark out all the veins. I’ll do this. Marking out all of the veins reduces the amount of bruising you get. So for people wondering, this is AccuVein macchine.
This is the Accuvein, a vein finder. It actually detects the veins and shoots out a laser image of where they are on the skin so you can mark them out. The veins are marked in red and we’ll mark where we are gonna do botox in black.
I always mark, because I think, when you mark the patient, you visualize what you are gonna do and there’s no guessing when you are doing it. There’s not (unintelligible), the very picture of what you want to do and you go ahead and do it.
Before I start, I mark. Frown, quite a strongish frown. Even though (giggling) – Even though what? – You had botox recently but it still is working. – No, only three months ago. – Three months, okay. Raise your eyebrows.
Very strong in the central part of you. – I know. – The central part of your forehead you have a lot of strength there. – I’m a strong woman. – You’re a strong woman. Raise your eyebrows again. In order to make sure that we hit, we have to hit these areas above the brow.
It seems like its a lot of injections going on there. The muscle is fairly large muscle. Your ears are red. – It’s fine. (giggling) – There its done, its good. (both giggling) A strong muscle and the muscle is actually quite a wide muscle because that’s the nature of the frontalis muscle.
The best way to get the best results from botox in the forehead muscle is to actually do lots of little injections. And that’s what we’ve done, that’s what we’ve done here. Notice also, that the frown muscle has not been done too high.
We are not gonna infiltrate the frontalis muscle from doing the frown corrugator muscle. Nice and low. Exactly where they should be. Not up here. But in here. Right along the muscle. Frown again for me.
So that’s right in the muscle belly. Because we are injecting above the eyebrow here we can inject a little bit here as well. As insurance. Injecting under the brow, that’s our insurance policy because it helps protect against the effects of the botox in the forehead muscle which tend to push down.
This will neutralize that effect. However, if I don’t botox this area here. If I don’t put botox in there, I’m gonna get a lot of elevation there and that’s gonna look weird. Definitely botox that area there.
Here’s our botox. To help with pain we are gonna use a bit of ice and a bit of vibration. A bit of ice and vibration. Not too much ice, it will give you a brain freeze. With care not to go into any of the veins.
How does that feel? – It’s good. – Yeah, not too bad. – Not too bad. – You are getting a lot of injections. – I know. – Now we decided not to make you into Mrs. Spock today. – Thank you, Gavin. – It’s funny that most patients will ask you for an arched brow but I think what the key is you have to talk them out of it because that’s just a poor outcome, I think.
It gives you away. It’s very important to do so cause without the right expectations you are never gonna get a happy patient. Alright, that’s done. That was the forehead. Now we will do the frown muscles.
First we will inject the procerus muscle which pulls the brown down and gives you a horizontal crease in the nose. And now the corrugator muscle which pulls the frown together and gives you vertical lines.
Remember static lines are different to dynamic lines. Static lines are lines which are there at rest, regardless of whether you are frowning or not or expressing or not. Dynamic lines are there only when you move or express.
So we are done. So we see how that treatment goes and we will see if she gets a Dr. Spock look when she comes back in for a check up. It’s been two weeks since we treated Amelia and we’ve got her back here for review.
So you can see the results and see whether we gave her a Dr. Spock or not. How’d you go, Amelia, with your treatment? – Very well, I’m very happy. – That’s good, great. You look very nice. Let’s look at your frown.
There’s a little bit of frown remaining there, so we may need to top that off a little bit for her. Raise your eyebrows for me. Okay, now notice the left eyebrow does raise a little more than the right.
Do that again. That could be due to a number of factors. It could be due to having more strength on the left side naturally. It could be due to the depth of injection which is hard to monitor sometimes.
But we know the dose and the placement exactly. I was quite happy with the dose and placement, but nonetheless, you can still have a difference in effect on both sides. That’s why it’s important to get people back and have a look and check on their result to see if they do need a top off.
We do top offs for patients if required and usually we don’t charge patients for that. Imagine if we didn’t inject over this part here. If we didn’t inject over the lateral eyebrows. Raise your eyebrows again.
Now really, there is a little bit of lateral brow elevation, even despite the fact that we injected over those areas. Raise your eyebrows again. There is also a bit of wrinkle up there that we need to get rid off as well.
But imagine if we didn’t inject her lateral eyebrows. She would be looking very, very unusual right now. And it goes to show, even though she was stronger centrally in her forehead, her lateral forehead muscles are strong enough to cause an elevation.
We are gonna do a little top off on Amelia’s forehead and frown. (squeaking) Generally, we don’t need to leave any movement with the frown, it’s the muscle causes a negative expression so we just take it out – No negative emotion.
Raise your eyebrows. So there, there. Relax, again. There, there, raise up. There too. Okay. Alright, we are gonna top off these areas with a bit. Raise up again. You have extra. – Extra frozenness. – Extra frozenness.
It’s interesting, despite the fact that we put a fair amount in, she’s still got some movement and it looks very natural. – Why would that be, I don’t know why. – It’s all done, all done. – All done, bye.
– So in conclusion, it is important to do botox in such a way that you look natural, that you don’t look arched or Dr. Spock’d and you can see here that it is not hard to excellently do that. And it’s all about balancing up the actions of the muscles and not being fearful of injecting over the brow and being fearful of causing brow droop.
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