Whoever is performing your injections should be assessing your brow position with your eyes closed! Frontalis 20 Units divided in 4 sites † Temporalis ... Safety and effectiveness of BOTOX ® have not been established for the treatment of other upper or lower limb muscle groups. I hope to add some real patient photos and ultrasound images in here to give you a better visualization soon! If you can understand these concepts, then you are steps ahead of many people that receive Botox/Dysport as well as many injectors! Dr Jordan Rihani is one of the best surgeons for facial plastic surgery, as well as facial cosmetic enhancements, in Texas. (Which I think is the better question since we are playing a tug of war with the brow and we simply want to weaken the corrugator MORE than the frontalis. If all this sounds rather confusing, then don’t worry! Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration and whenever the solution and the container permit. Botox treats these wrinkles by relaxing your frontalis muscle; this can make it difficult to raise your eyebrows. Pediatric Spasticity: Pediatric Upper Limb Spasticity. An effective dose for facial lines is determined by gross observation of the patient’s ability to activate the superficial muscles injected. Do not freeze reconstituted BOTOX Cosmetic. The potency Units of BOTOX Cosmetic (onabotulinumtoxinA) for injection are specific to the preparation and assay method utilized. The location, size, and use of the muscles vary markedly among individuals. The frontalis muscle is the large facial muscle that spreads across the forehead. Crow’s feet are the second most frequent type of wrinkles treated with Botox. This muscle pulls the eyebrow down and inward. Dr. Jordan Rihani is a national trainer and lecturer on injectable treatments and is considered one of the top injectors in Dallas Fort Worth. If this is injected, then there simply is nothing that can elevate the brow. I want to outline proper assessment of brow position and how to avoid the much feared brow drop – for injectors and patients alike. Only when we close our eyes and really relax our forehead can the true brow position be assessed. Any questions? The injector actually must weaken the muscles that pull down the brow. For simultaneous treatment with glabellar lines, the dose is 24 Units for lateral canthal lines and 20 Units for glabellar lines (see Glabellar Lines Administration and Figure 1), with a total dose of 44 Units. Treat forehead lines in conjunction with glabellar lines (see Glabellar Lines Administration and Figure 1) to minimize the potential for brow ptosis. Again, this is the common misconception and something I educate my patients about. Forehead lines arise largely from the activity of the frontalis muscles. Then slowly inject the diluent into the vial. Gently mix BOTOX Cosmetic with the saline by rotating the vial. Look at the patient and see them move their muscles. If you weaken the upper forehead (frontalis) muscles, you will not get a brow lift, your brow will drop. Dr Jordan Rihani is one of the best surgeons for facial plastic surgery, as well as facial cosmetic enhancements, in Texas. As my patients get older, I actually use less Botox in order to preserve a higher brow position. So how does one inject the entire corrugator without injecting the frontalis muscle? Preferably someone with a strong background and understanding of the facial anatomy and how it functions. On the lower treatment row at the midline of the face, and 0.5 – 1.5 cm medial to the palpated temporal fusion line (temporal crest); repeat for the other side. Alternatively, if the lines in the lateral canthal region are primarily below the lateral canthus, inject per Figure 3. This muscle moves the brow superiorly, interacting with the procerus, orbicularis, corrugator, and depressor supercilli. The recommended total dose for treatment of forehead lines (20 Units [0.5 mL]) in conjunction with glabellar lines (20 Units [0.5 mL]) is 40 Units (1mL). If your brow position sits below the rim of the eye socket with your eyes closed, Botox/Dysport should be used very conservatively in the frontalis muscle to prevent brow drop. BOTOX Cosmetic should be administered within 24 hours after reconstitution. The first injection (A) should be approximately 1.5-2.0 cm temporal to the lateral canthus and just temporal to the orbital rim. There are so many intermingling fibers that the two all meet in one point at the skin. • Lateral corrugator injections should be placed at least 1 cm above the bony supraorbital ridge. He is a national trainer on injectables as well as a Clinical Assistant professor at UT Southwestern Medical Center. Table 1: Dilution Instructions for BOTOX Cosmetic Vials (100 Units and 50 Units), We comply with the HONcode standard for trustworthy health information -, Botox injection, powder, lyophilized, for solution, The carton labeling does not contain an intact seal with a translucent silver Allergan logo (on both ends of the carton) or the seal has a black circle with a diagonal line through it (i.e., prohibition sign), The vial label does not contain a holographic film containing the name “Allergan” within rainbow-colored horizontal lines, The U.S. License number 1145 is not present on the vial label and carton labeling [see How Supplied/Storage and Handling (, Superior Margin of Frontalis Activity: approximately 1 cm above the most superior forehead crease, Lower Treatment Row: midway between the superior margin of frontalis activity and the eyebrow, at least 2 cm above the eyebrow, Upper Treatment Row: midway between the superior margin of frontalis activity and lower treatment row.