Data sources include IBM Watson Micromedex (updated 1 Oct 2020), Cerner Multum™ (updated 1 Oct 2020), Wolters Kluwer™ (updated 30 Sep 2020) and others.

BOTOX Cosmetic should be administered within 24 hours after reconstitution.

See where the muscle belly is located, pinch it, then inject it. If the lines in the lateral canthal region are above and below the lateral canthus, inject per Figure 2. The larger muscle of the forehead, the Frontalis muscle is actually the only muscle responsible for lifting the brow. The duration of effect of BOTOX Cosmetic for glabellar lines is approximately 3-4 months. Between your eyebrows you have a muscle complex called the glabella. This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment. The frontalis muscle is the large facial muscle that spreads across the forehead. Last updated on Jul 16, 2020. Don’t hesitate to email me: jordan@rihanimd.com. This frontalis is responsible for raising your eyebrows and wrinkling your forehead. Glabellar facial lines arise from the activity of the corrugator and orbicularis oculi muscles. These fingerlike insertions are spread across nearly the entire brow and travel from the deeper galeal layer up to the skin. For more information about this topic you can see my post on the Botox Browlift: https://facialplasticsurgeryinstitute.com/2017/11/17/the-botox-browlift/, So how do the muscles of the brow play together? The recommended total dose for treatment of forehead lines (20 Units [0.5 mL]) in conjunction with glabellar lines (20 Units [0.5 mL]) is 40 Units (1mL). Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances. Injections should be given with the needle bevel tip up and oriented away from the eye. If this is injected, then there simply is nothing that can elevate the brow. • Lateral corrugator injections should be placed at least 1 cm above the bony supraorbital ridge. • Ensure the injected volume/dose is accurate and where feasible kept to a minimum.
He is a national trainer on injectables as well as a Clinical Assistant professor at UT Southwestern Medical Center.
Record the date and time of reconstitution on the space on the label. For patients with a low brow, the best correction that can both raise the brow and eliminate forehead wrinkles is a Browlift. Treat forehead lines in conjunction with glabellar lines (see Glabellar Lines Administration and Figure 1) to minimize the potential for brow ptosis. Endoscopic browlifts are done through small incisions in the hairline and have minimal downtime. So now that we know where the frontalis muscle inserts, we need to understand how the frontalis inserts to lift the skin of the brow and create expressions.

Dr Jordan Rihani is one of the best surgeons for facial plastic surgery, as well as facial cosmetic enhancements, in Texas. The Corrugator Supercilii and Frontalis muscles relationship and how it pertains to Botox and Dysport injections.

The corrugator muscle starts on the bone just underneath the middle brow along the rim of the eye socket. Botox works by weakening muscles. Lines induced by facial expression occur perpendicular to the direction of action of contracting facial muscles. Remove the needle used to reconstitute the product and attach a 30-33 gauge needle. In order to reduce the complication of ptosis the following steps should be taken: • Avoid injection near the levator palpebrae superioris, particularly in patients with larger brow depressor complexes. This is a common request I receive from patients and is something not all injectors know how to assess properly. Confirm the patency of the needle. If you weaken the upper forehead (frontalis) muscles, you will not get a brow lift, your brow will drop. Physicians administering BOTOX Cosmetic must understand the relevant neuromuscular and structural anatomy of the area involved and any alterations to the anatomy due to prior surgical procedures and disease. The first injection (A) should be approximately 1.5-2.0 cm temporal to the lateral canthus and just temporal to the orbital rim. The potency Units of BOTOX Cosmetic (onabotulinumtoxinA) for injection are specific to the preparation and assay method utilized. If you can understand these concepts, then you are steps ahead of many people that receive Botox/Dysport as well as many injectors! Frontalis contraction causes brow elevation. The injector actually must weaken the muscles that pull down the brow. There are so many intermingling fibers that the two all meet in one point at the skin. Dr. Jordan Rihani is a national trainer and lecturer on injectable treatments and is considered one of the top injectors in Dallas Fort Worth. So let’s talk about the corrugator muscle. Any questions? Draw at least 0.5 mL (for glabellar lines), 0.6 mL (for lateral canthal lines), or 1 mL (for forehead lines treated in conjunction with glabellar lines) of the properly reconstituted toxin into the sterile syringe, preferably a tuberculin syringe and expel any air bubbles in the syringe barrel.

If your brow position sits below the rim of the eye socket with your eyes closed, Botox/Dysport should be used very conservatively in the frontalis muscle to prevent brow drop. They are not interchangeable with other preparations of botulinum toxin products and, therefore, units of biological activity of BOTOX Cosmetic cannot be compared to nor converted into units of any other botulinum toxin products assessed with any other specific assay method [see Warnings and Precautions (5.1) and Description (11)]. Alternatively, if the lines in the lateral canthal region are primarily below the lateral canthus, inject per Figure 3. The answer is simply that there are insertions to the skin at the level of the brow. Frontalis contraction causes brow elevation. If you are interested in seeing Dr. Rihani for a treatment please give us a call to schedule. Do not use BOTOX Cosmetic and contact Allergan (1-800-890-4345) if: BOTOX Cosmetic is supplied in single-dose 50 Units and 100 Units per vial. Select one or more newsletters to continue. As my patients get older, I actually use less Botox in order to preserve a higher brow position. People naturally lift their brows when their eyes are open. This can be done through an endoscopic approach in most cases. Indication specific dosage and administration recommendations should be followed. Locate the following horizontal treatment rows by light palpation of the forehead at rest and maximum eyebrow elevation: Inject 4 Units (0.1 mL) of reconstituted BOTOX Cosmetic into 5 sites in the frontalis muscle, for a total of 20 Units (0.5 mL).

Do not freeze reconstituted BOTOX Cosmetic. If this is injected, then there simply is nothing that can elevate the brow. Forceful contraction of the orbicularis oculi results in lateral and radially oriented folds (crow’s feet lines) which originate from the lateral canthus. The larger muscle of the forehead, the Frontalis muscle is actually the only muscle responsible for lifting the brow.


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