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Myobloc for Wrinkles :: Techniques
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Forehead Lines
To treat forehead lines: inject 0.1cc (500 Myobloc units) across the forehead as shown in the figure. Myobloc injections in the forehead can dramatically affect eyebrow shape, therefore, prior to injecting the forehead it is necessary to consider whether you want to enhance the arch of the eyebrow or if you want the eyebrow to be more horizontal.
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Illustration from the textbook Baumann L. "Cosmetic Dermatology: Principles
and Practice" McGraw Hill, Philadelphia, March 2002.
Generally, women prefer a more arched brow because it imparts a more feminine look, while men prefer a more horizontal brow.
Brow Characteristics
Feminine brows
Arched
Longer lid to brow distance
Thinner brow
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Masculine Brows
Horizontal
Lower lid to brow distance
Thicker brow
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Pitfalls of forehead injections:
- unwanted eyebrow shape
Although an arched brow pattern may be desired, using too much of a V shaped technique can lead to an unnatural V shaped pattern of the brow.
"A V- shaped injection pattern can cause an
undesired "diablo" or "devil" shaped eyebrow. This can be remedied by the
addition of 2 injections of Myobloc in the lateral forehead 1 cm above the
brow."
- brow ptosis
This can be largely avoided with injection experience and by not injecting into the danger zone 1 cm above the brow as shown in the diagram.
Illustration from the textbook Baumann L. "Cosmetic Dermatology: Principles
and Practice" McGraw Hill, Philadelphia, March 2002.
- drooping eyelids
It is important not to over-inject the forehead area because this will lead to a heaviness or droopiness of the upper eyelids. This occurs because these patients need the upward pulling of the frontalis muscle to raise the baggy upper eye skin. In fact, Myobloc should not be injected in the lower forehead of patients with excess or droopy upper eyelid skin. This patients should be referred for an upper lid blepharoplasty prior to Myobloc injections for maximum patient satisfaction.
The physician should warn all patients with low forehead wrinkles just above the eyebrow that these wrinkles cannot be treated with botulinum toxin. (If treated they can lead to upper lid droopiness) Therefore, these wrinkles will still be noticeable above the eyebrows on brow elevation as seen in the figure.
In the author's opinion, injections of the forehead are an art and the physician must know what eyebrow shape will be most flattering to the patient, in addition to knowing how to achieve this shape. In many cases, with proper technique, the eyebrows can be shaped to give a much younger appearance. In addition, the forehead can be smoothed as shown in the following pictures.
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