- 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.