Patient: A 54-year-old woman with low-lying brows at rest.
Treatment Issue: Combining botulinum toxin type A (Botox Cosmetic) and a dermal filler, in this case Restylane, to perform a bilateral brow lift.
Treatment
This patient received 28 units of Botox into the glabellar complex and 3 units of Botox into each orbicularis oculi just under the eyebrow. In addition, we injected Restylane 0.25 cc apiece under the brow laterally and medially.
Technique
As is typically the case with combined therapies, precise placement of both products is paramount. On the first visit, the patient is evaluated while seated upright. Topical anesthetic and the judicious use of ice permit increased pain control and help to minimize bruising post-treatment.
The site for injection is marked, and we begin with Botox treatment to the glabellar complex; 28 units total is utilized at five injection sites.
An additional injection of 3 units of Botox is placed just under each lateral brow. The precise site of injection at the lateral orbicularis oculi can be located by first having the patient squint while we mark the site on the skin of maximum vector inferior-medial pull.
Then we ask the patient to lift her brows, and we mark the lateral temporal fusion line. Inject one site for the “Botox brow-lift” that will relax the pull downward of the lateral brow by the orbicularis oculi, making sure that this point is at least 1 cm from the lateral frontalis fibers at the temporal fusion line. This helps to avoid unwanted diffusion to the frontalis because this would offset the desired lift of the lateral brow.
After 2 weeks, we have the patient return for evaluation of the Botox injection. If the patient still needs to achieve the desired lift of the lateral brow, we will inject Restylane under the eyebrow laterally and medially to anchor a manual lifting of the brow. Explicit care must be taken in this highly vascular area, with close attention paid for any sign of vascular compromise in the form of cutaneous blanching. Minimal Restylane (0.15 cc to 0.3 cc) is actually needed to achieve successful lifting. The focal point created by the injection allows for a better framing of the eye and a more alert appearance.
Tips
1. Inject Botox first and allow
2 weeks for a final outcome.
2. If needed, add a dermal filler to improve clinical outcome and extend the longevity of improvement.
Points to Remember
Vascular compromise represents the greatest risk in this anatomic area. Also, too much filler can lead to a nodular appearance. n
Patient: A 54-year-old woman with low-lying brows at rest.
Treatment Issue: Combining botulinum toxin type A (Botox Cosmetic) and a dermal filler, in this case Restylane, to perform a bilateral brow lift.
Treatment
This patient received 28 units of Botox into the glabellar complex and 3 units of Botox into each orbicularis oculi just under the eyebrow. In addition, we injected Restylane 0.25 cc apiece under the brow laterally and medially.
Technique
As is typically the case with combined therapies, precise placement of both products is paramount. On the first visit, the patient is evaluated while seated upright. Topical anesthetic and the judicious use of ice permit increased pain control and help to minimize bruising post-treatment.
The site for injection is marked, and we begin with Botox treatment to the glabellar complex; 28 units total is utilized at five injection sites.
An additional injection of 3 units of Botox is placed just under each lateral brow. The precise site of injection at the lateral orbicularis oculi can be located by first having the patient squint while we mark the site on the skin of maximum vector inferior-medial pull.
Then we ask the patient to lift her brows, and we mark the lateral temporal fusion line. Inject one site for the “Botox brow-lift” that will relax the pull downward of the lateral brow by the orbicularis oculi, making sure that this point is at least 1 cm from the lateral frontalis fibers at the temporal fusion line. This helps to avoid unwanted diffusion to the frontalis because this would offset the desired lift of the lateral brow.
After 2 weeks, we have the patient return for evaluation of the Botox injection. If the patient still needs to achieve the desired lift of the lateral brow, we will inject Restylane under the eyebrow laterally and medially to anchor a manual lifting of the brow. Explicit care must be taken in this highly vascular area, with close attention paid for any sign of vascular compromise in the form of cutaneous blanching. Minimal Restylane (0.15 cc to 0.3 cc) is actually needed to achieve successful lifting. The focal point created by the injection allows for a better framing of the eye and a more alert appearance.
Tips
1. Inject Botox first and allow
2 weeks for a final outcome.
2. If needed, add a dermal filler to improve clinical outcome and extend the longevity of improvement.
Points to Remember
Vascular compromise represents the greatest risk in this anatomic area. Also, too much filler can lead to a nodular appearance. n
Patient: A 54-year-old woman with low-lying brows at rest.
Treatment Issue: Combining botulinum toxin type A (Botox Cosmetic) and a dermal filler, in this case Restylane, to perform a bilateral brow lift.
Treatment
This patient received 28 units of Botox into the glabellar complex and 3 units of Botox into each orbicularis oculi just under the eyebrow. In addition, we injected Restylane 0.25 cc apiece under the brow laterally and medially.
Technique
As is typically the case with combined therapies, precise placement of both products is paramount. On the first visit, the patient is evaluated while seated upright. Topical anesthetic and the judicious use of ice permit increased pain control and help to minimize bruising post-treatment.
The site for injection is marked, and we begin with Botox treatment to the glabellar complex; 28 units total is utilized at five injection sites.
An additional injection of 3 units of Botox is placed just under each lateral brow. The precise site of injection at the lateral orbicularis oculi can be located by first having the patient squint while we mark the site on the skin of maximum vector inferior-medial pull.
Then we ask the patient to lift her brows, and we mark the lateral temporal fusion line. Inject one site for the “Botox brow-lift” that will relax the pull downward of the lateral brow by the orbicularis oculi, making sure that this point is at least 1 cm from the lateral frontalis fibers at the temporal fusion line. This helps to avoid unwanted diffusion to the frontalis because this would offset the desired lift of the lateral brow.
After 2 weeks, we have the patient return for evaluation of the Botox injection. If the patient still needs to achieve the desired lift of the lateral brow, we will inject Restylane under the eyebrow laterally and medially to anchor a manual lifting of the brow. Explicit care must be taken in this highly vascular area, with close attention paid for any sign of vascular compromise in the form of cutaneous blanching. Minimal Restylane (0.15 cc to 0.3 cc) is actually needed to achieve successful lifting. The focal point created by the injection allows for a better framing of the eye and a more alert appearance.
Tips
1. Inject Botox first and allow
2 weeks for a final outcome.
2. If needed, add a dermal filler to improve clinical outcome and extend the longevity of improvement.
Points to Remember
Vascular compromise represents the greatest risk in this anatomic area. Also, too much filler can lead to a nodular appearance. n
