Forehead Lift with Botox Microdroplet: A New Treatment Modality

Botulinum toxin (Botox®) is a medication used in facial rejuvenation and forehead lifts. It is a muscle relaxant , so it helps reduce expression lines . It has traditionally been used in three areas of the face: the frown line, the forehead, and the crow’s feet . Applied to these areas, it reduces muscle activity in a predictable manner and for a limited period of time. However, overdosing on certain areas, especially the forehead, results in an unnatural, paralyzed, expressionless appearance.

Dr. Kenneth Steinsapir , an oculoplastic surgeon in Beverly Hills, California, has designed a new type of forehead lift that seeks to rejuvenate the upper third of the face with botulinum toxin without the need to inject the forehead. This work is the result of Dr. Steinsapir’s several years of experience with this technique and was recently published in Ophthalmic Plastic and Reconstructive Surgery under the title ” Cosmetic Microdroplet Botulinum Toxin A Forehead Lift: A New Treatment Paradigm.” The treatment is innovative in two fundamental aspects. First, it uses “microdroplets” of botulinum toxin at each injection site. Traditionally, doses of between 2 and 5 units per injection site are used, while this technique uses a dose of 0.33 units per injection site.

Secondly, the treatment avoids injecting into the forehead , thus maintaining its mobility. How then can this treatment improve the forehead without injecting directly into its muscles? The treatment is aimed solely at relaxing the brow depressor muscles , that is, all the muscles that contract to lower the eyebrows. These muscles are the orbicularis oculi, the corrugators, and the procerus. By selectively and extensively relaxing all these muscles, the frontalis muscle of the forehead requires less contraction to raise the eyebrows, since its antagonist muscles offer little opposition. Therefore, the forehead will be more stretched but maintain its mobility , relaxing the space between the eyebrows and elevating the eyebrows. The goal is to achieve a lifting effect without surgery.

The procerus and corrugator muscles (between the eyebrows) are already commonly treated with botulinum toxin, but the main difference with this technique is the treatment of the orbicularis oculi muscle , which has a significant brow-depressing effect. Dr. Steinsapir has demonstrated that superficial treatment of this muscle with microdroplets of botulinum toxin is safe and produces a natural and reproducible lifting effect.

In short, this new type of forehead lift rejuvenates the upper third of the face by relaxing the muscles that depress the eyebrows, achieving a lifting effect with significant improvement in the area between the eyebrows, crow’s feet, and forehead, while maintaining the mobility of the latter.