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The understanding of how BOTOX® Cosmetic and other neurotoxins selectively weaken some muscles while allowing other muscles to function more strongly is something that I lectured about extensively back at the turn of this century. I called it differential pull.1,2
This concept, where a weakened portion of the muscle strengthens other portions and allows lifting to occur (because the muscles work more efficiently without the resistance of their antagonist’s muscle), was applied to lift the jowls, the lax platysma muscles in the neck, and the brows. Each of these vectors of pull resulted in a publication where these principles were demonstrated.2-5
At W Cosmetic Surgery, we’ve been using these principles ever since.5 And they have evolved significantly since then. Dr. Steinsapir pioneered a technique he patented called microdropletTM BOTOX® Cosmetic—which is characterized by the addition of the neurotoxin in small quantities to weaken only certain portions of the eyebrow muscles to lift the brows and improve the horizontal wrinkles in the forehead. By segmentally weakening the muscles that frown, the muscles that lift the brow and the paired frontalis muscles work more effectively, and, therefore, wrinkles become less apparent.6
What Has Changed in the BOTOX® Brow Lift?
If you’ve been in lately for a BOTOX® brow lift or a chemical brow lift (a lift with any other neurotoxin such as Dysport®, XEOMIN®, or Jeuveau®), you may have noticed that we now inject you above your hairline, often inches above it.
This is because there is also a muscle—the occipitalis—that acts simultaneously with the muscles that elevate the brow (these muscles actually depress the hairline when you lift your brow). We’ve found that treating the occipitalis muscle in conjunction with a chemical brow lift can lift your brow even higher because weakening the occipitalis makes the frontalis work even more efficiently.
While we don’t think this is done universally or accepted as a standard yet, we do feel that it will be, and we intend to present and publish our results. Injecting in this location lessens forehead wrinkles without dropping the brows, and it provides a natural and effective brow lift in patients that would otherwise require a surgical brow lift. If you are a new patient, we can discuss the “above the hairline” injection with you at the time of your consultation for any neurotoxin. We think it will become the standard.
Interested in Learning More?
1. “The Botox ‘Facelift'” Annual Meeting of the European Academy of Cosmetic Surgery, Berlin, May, 2001.
2. Wulc AE, Rosen BR, Foster JA, Holck DEE, Perry JD: Facelift with Botulinum
Toxin Type A, 2001 American Society of Ophthalmic Plastic and Reconstructive Surgery
Scientific Symposium, New Orleans, Louisiana, November 2001.
3. Lower face treatment with Botox, American Academy of Ophthalmology, Orlando, Florida, October, 2002
4. Foster JA, Wulc AE, Holck DEE. Castro E, Huang W: The Botox browlift. Annual Meeting of the American Society of Ophthalmic Plastic and Reconstructive Surgery, Orlando, Florida, October 1999.
5. Foster JA, Proffer PL, Proffer LH, Wulc AE, Perry JD; Modifying Brow With Botulinum Toxin, Internal Ophthalmology Clinics, 2005 45 (3) : 123-131.
6. Steinsapir KD, Rootman D, Wulc AE, Hwang C. Cosmetic Microdroplet Botulinum Toxin A Forehead Lift: A New Treatment Paradigm. Ophthal Plast Reconstr Surg. 2015: Jul-Aug;31(4):263-8.