How To Inject Botox Under The Brow | Botox Brow Lift Advice

Summary

In this educational video, the speaker addresses concerns about eyelid ptosis when performing a brow lift injection. They explain the anatomy of the eye muscles, emphasizing that injecting the orbicularis oculi muscle can actually lift the eyelid rather than cause ptosis. The video provides insights on safe injection techniques, including the importance of depth and the use of small doses, while also discussing the effects of treating the frontalis muscle. The speaker shares their personal strategies for achieving a natural brow lift without causing unwanted side effects.

Takeaways

• 😲 The video discusses the fear of causing eyelid ptosis when injecting under the eyebrow and aims to clarify the anatomy involved.
• 🤔 The presenter reflects on training experiences with an ophthalmologist who used higher doses without causing eyelid ptosis, sparking interest in the anatomy.
• 👁️ When the eyelid is purposefully injected with Toxin, it actually lifts rather than droops due to the action of the superficial muscles.
• 💉 The levator palpebrae muscle is the retractor muscle in the orbit, and caution is advised when injecting near it to avoid eyelid ptosis.
• 🔍 Understanding the muscle layers and their functions is crucial for safe injection practices around the eye area.
• 🍔 The presenter uses a sandwich analogy to explain the protective layers in the face, emphasizing the importance of depth in injection to avoid complications.
• 📏 Injecting small doses (like 1 unit) is safer and can effectively affect the fibers pulling the eyebrow down without causing a mess.
• 💧 The standard dilution for Botox is 2.5 mils in 100 units, but a more concentrated form can be used for specific areas to minimize spread.
• 🚫 Injecting above the eyebrow in the frontalis muscle can decrease its lifting power and potentially cause a drop, contrary to what some patients believe.
• 🤨 The 'cat ears' or lateral parts of the frontalis muscle should be treated cautiously to avoid brow ptosis, especially in females who use their eyebrows differently.
• 👐 The balance between treating and not treating certain areas is crucial to avoid an uneven brow lift or a 'Spock brow' appearance.

Q & A

What is the main concern when injecting under the eyebrow?

The main concern is causing eyelid ptosis, which is a drooping of the upper eyelid.

Why did the ophthalmologist's method of injecting near the eyelid not cause eyelid ptosis?

The ophthalmologist was using a large amount of units (four times more than usual) and had never experienced eyelid ptosis, suggesting that the technique or the amount of units used might not be the sole factor in causing ptosis.

What is the role of the superficial muscles in the eyelid?

The superficial muscles in the eyelid, known as the retractors, are responsible for lifting the eyelid. When these muscles are injected, the eyelid can actually lift, contrary to common belief.

What muscle is responsible for eyelid retraction and is a concern when injecting?

The levator palpebrae superioris muscle is the retractor muscle responsible for eyelid retraction and is the muscle of concern to avoid injecting near.

What is the orbicularis oculi muscle and how does it affect the eyelid when injected?

The orbicularis oculi muscle is responsible for closing the eyes. When injected, it can actually allow the eyelid to open slightly, as it relaxes the muscle that contracts during eye closure.

Why does injecting the orbicularis oculi muscle not cause eyelid ptosis?

Injecting the orbicularis oculi muscle weakens the muscle that pulls the eyelid down, which can actually result in the eyelid lifting slightly, rather than causing ptosis.

What is the significance of understanding the layers of the face when injecting Botox?

Understanding the layers helps to ensure that the injection is placed correctly, protecting the important structures in the orbit and avoiding complications like eyelid ptosis.

How many units of Botox are typically used for injections under the eyebrow?

The speaker prefers using just one unit per injection point, as it is enough to affect the fibers pulling the eyebrow down and is a safer amount to minimize complications.

What is the standard dilution used for Botox injections according to the speaker?

The standard dilution used is 2.5 mils in 100 units of botulinum toxin.

Why might injecting above the eyebrow cause a different effect than injecting below?

Injecting above the eyebrow affects the frontalis muscle, which is an elevator of the eyebrow. Injecting this muscle could decrease its power to lift, potentially causing a drop instead of a lift.

What is the 'cat ear' area and why is it treated with caution?

The 'cat ear' area refers to the lateral part of the frontalis muscle. It is treated with caution because injecting this area could lead to a loss of the eyebrow arch and difficulty in elevating the eyebrow, especially in females who use their eyebrows differently.

What is the difference between brow ptosis and eyelid ptosis?

Brow ptosis refers to the drooping of the eyebrow, while eyelid ptosis refers to the drooping of the upper eyelid. The script discusses how treatments can affect these differently.

Why might a Spock brow occur and how can it be avoided?

A Spock brow, characterized by a medial brow ptosis and a lateral brow lift, can occur if the middle of the brow is overtreated and the sides are undertreated. To avoid this, a balanced approach to treatment is necessary, adjusting based on the individual's response.

What is the importance of the depth of injection when injecting around the eye?

The depth of injection is crucial for safe injecting around the eye. It ensures that the botulinum toxin is placed accurately to affect the intended muscles without damaging the important structures in the orbit.

Outlines

00:00

🤔 Understanding Eyelid Anatomy for Safe Injections

This paragraph discusses the intricacies of injecting beneath the eyebrow without causing eyelid ptosis. The speaker reflects on their early training and an ophthalmologist's approach to injections, which was contrary to common fears. The focus is on the anatomy of the muscles around the eye, explaining that the levator palpebrae muscle is the retractor and should be avoided during injections. The orbicularis oculi muscle, when injected, can actually lift the eyelid due to its function. The speaker uses the analogy of a sandwich to illustrate the protective layers between the injection site and the orbit, emphasizing the importance of depth of injection over position relative to the eyelid. They also address common misconceptions about the effects of injecting the frontalis muscle and the role of the orbicularis oculi in brow lifting.

05:02

💉 Injection Techniques and Dosage for Brow Lift

The speaker elaborates on the technique and dosage used for brow lifting injections. They prefer using minimal units, typically one to three, to avoid complications and achieve a subtle effect. The importance of injection depth and the protective layers of the face are reiterated. The paragraph also covers the standard dilution used and the speaker's approach to using more concentrated forms in specific areas to minimize spread. The discussion includes the effects of injecting above and below the eyebrow, clarifying that injecting the elevator muscles of the eyebrow can actually cause a drop. The speaker also touches on the concept of 'cat ears' in brow lifting, explaining their cautious approach to treating this area, especially in females, due to its impact on eyebrow movement and makeup application.

10:02

👁️‍🗨️ Safe Injection Practices Around the Eye

In the final paragraph, the speaker summarizes the key muscles involved in eyelid movements and the importance of understanding their three-dimensional relationships for safe injecting practices. They highlight the levator palpebrae, orbicularis oculi, and frontalis muscles, emphasizing that injection depth is paramount for safety. The speaker advises on a cautious initial approach, observing the results after two weeks before making adjustments, and stresses the importance of learning from each patient's unique response to treatment.

Keywords

💡Brow Lift

A brow lift is a cosmetic procedure that aims to raise the eyebrows to a higher position on the face, often to reduce the appearance of aging or to correct drooping. In the video, the speaker discusses the technique of injecting substances like Botox underneath the eyebrow to achieve a brow lift without causing eyelid ptosis, which is a key concern in such procedures.

💡Eyelid Ptosis

Eyelid ptosis refers to the drooping of the upper eyelid, which can be a natural part of aging or a side effect of certain cosmetic procedures. The video script emphasizes the importance of understanding the anatomy of the eye area to avoid causing this condition during a brow lift.

💡Anatomy

Anatomy, in this context, refers to the study of the structure of the body, particularly the muscles and layers around the eye area. The script explains how a proper understanding of anatomy is crucial for safely performing cosmetic injections to avoid complications like eyelid ptosis.

💡Orbicularis Oculi

The orbicularis oculi is a muscle that encircles the eye and is involved in the closing of the eyelids. The script clarifies that injecting this muscle can actually cause the eyelid to lift slightly, contrary to common misconceptions, because it is a retractor muscle, not a protractor.

💡Levator Palpebrae Superioris

The levator palpebrae superioris is the muscle responsible for lifting the upper eyelid. The video explains that this muscle is located in the orbit and is the muscle of concern when trying to avoid eyelid ptosis during injections, as it is the primary elevator of the eyelid.

💡Injection Points

Injection points refer to the specific locations where Botox or other substances are injected to achieve a desired cosmetic effect. The script discusses concerns about injection points being too close to the eyelid and the importance of knowing the underlying anatomy to avoid complications.

💡Botox

Botox is a brand name for botulinum toxin, a substance used in cosmetic procedures to temporarily paralyze muscles, reducing wrinkles and achieving other effects. The video script uses Botox as an example of a substance that can be injected to lift the brow, with a focus on safe injection techniques.

💡Dilution

Dilution in this context refers to the process of mixing botulinum toxin with a liquid, such as bacteriostatic saline, to achieve the desired concentration for injection. The script mentions different dilution ratios that can be used depending on the area being treated.

💡Dose Response Curve

The dose response curve is a concept in pharmacology that describes the relationship between the dose of a drug and its effect. In the video, the speaker mentions using smaller doses of Botox to be safer and to avoid complications, illustrating the principle of the dose response curve.

💡Frontalis Muscle

The frontalis muscle is a muscle in the forehead that is responsible for raising the eyebrows. The script discusses how injecting this muscle can affect the brow lift and the importance of treating it with caution to avoid an unnatural appearance or complications.

💡Cat Ears

Cat ears refer to the elevated areas of the frontalis muscle that can become more noticeable when the muscle is treated with Botox. The script mentions avoiding injecting in these areas to prevent a loss of eyebrow arch and to maintain a natural look.

Highlights

The video discusses the technique of injecting under the eyebrow without causing eyelid ptosis, an important aspect of facial anatomy understanding.

A personal anecdote from the trainer's early career about an ophthalmologist's unconventional injection technique without eyelid ptosis.

Explanation of the superficial muscles in the eyelid being protractors, not retractors, which is contrary to common misconceptions.

The levator palpebrae muscle is the actual retractor muscle of concern when injecting, not the orbicularis oculi.

Injecting the orbicularis oculi can actually cause the eyelid to lift, which is a treatment for eyelid ptosis.

Differentiating between the causes of eyelid ptosis and strategies to avoid it through careful injection.

The trainer's personal experience of never causing eyelid ptosis in their patients due to a specific injection style.

The importance of understanding muscle involvement and the effects of toxin injections to avoid complications.

A detailed anatomy lesson using the sandwich analogy to explain the layers of facial muscles and fat pads.

The significance of injection depth over position in ensuring the safety of internal eye structures.

The trainer's preference for using a one-unit dose for injections under the eyebrow for safety and effectiveness.

Discussion on the standard dilution of botulinum toxin and when to use a more concentrated form.

The brow lift effect from injections both below and above the eyebrow, and the misconceptions about their effects.

Clarification on the difference between a brow ptosis and an eyelid ptosis, and common confusion among injectors.

The trainer's approach to treating the 'cat ears' of the frontalis muscle and its impact on brow lift and makeup application.

Advice on cautious treatment of the cat ear area, especially for first-time patients, and the importance of follow-up adjustments.

The concept of a 'Spock brow' and how over-treatment of the middle brow can lead to an unpleasant appearance.

The importance of three-dimensional injection depth for safe injecting around the eye, summarized as the key takeaway.

Transcripts

I recently posted a video on how to do a

brow lift and many of you ask questions

on how I was able to inject underneath

the eyebrow and not cause an eyelid

ptosis now unpacking this is a very

interesting way of understanding the

anatomy because of course we are all

very afraid of causing eyelid ptosis now

many years ago when I first started

training I remember training an

ophthalmologist who told me that they

injected the eyelid close to where I was

just warning my trainees to be careful

of injecting and they used four units so

four times more than I would normally

use and he'd never had an eyelidosis and

this really got me thinking much more

about the anatomy so by the end of the

show if you watch it all you should

understand the nuances of different

muscles and how they are differently

affected to what you may have first

thought when you first learned how to

inject Botox in this area so many people

were concerned that my injection points

were so close to the eyelid that I may

cause an eyelid drop now let's first

consider what actually happens if you

inject the eyelid so people have

purposefully injected the eyelid with

Toxin and you'll be surprised to find

out if you didn't know this already that

what will actually happen is your eyelid

will actually lift and that is because

the superficial muscles that are in the

eyelid are actually the protractors of

the eyelid they are not the retractors

so the retractor muscle is the levator

pulpary muscle which runs in the orbit

and this is what we are concerned about

not injecting whereas the orbicularis

oculi which actually runs in the eyelid

if you inject that actually allows your

eyelid to open slightly because when you

close your eyes it's Contracting you

relax it it actually opens so it's

actually the reverse of what many people

think because they haven't thought about

where the muscle that lifts the eyelid

actually lives which is in your orbit so

understanding this is the first thing

about around why you don't need to worry

too much around eyelid ptosis but there

are other elements too because of course

we can get eyelid ptosis from injecting

superior to the eye so we need to think

about what injections are likely to be

causing that and what we can do to avoid

it and why my style of injection in my

career has never caused anilitosis in

any of my patients so that's part one of

what to understand we need to think

about which muscles are likely to be

involved and what injecting toxin

actually does to them if you're

injecting superficially and you inject

orbicularisoculi you will find the

eyelid is actually more likely to lift

in fact it's now a treatment for eyelid

ptosis when you've injected the other

muscle the levator pulpry muscle knowing

precisely where these muscles are and

what layer they're in will give you

confidence to inject in areas where

other less thought out clinicians will

think you're going to get an eyelidosis

so let's think about the layers in this

area obviously at the top you have the

dermis then you have a thin layer of fat

in the hypodermis and then you have the

orbicularis oculi muscle underneath that

there's the retrobicularis oculi fat pad

then you have the orbital septum and

underneath that you have the preceptor

fat pads and underneath that you have

the levator pulpary muscle so there are

actually multiple layers so to help you

understand this let's think about the

face and the anatomy in this area not

with all the difficult medical terms but

just as a sandwich imagine that you're

having a sandwich on your mum's favorite

tablecloth that represents the most

precious part of the anatomy the orbit

we don't want to get ketchup on the

precious tablecloth and of course if you

make your sandwich directly on the table

cloth you're going to make a huge mess

and cause your mum a lot of upset or

your dad might be dad's favorite

tablecloth too

um but what we actually do in real life

is you have layers that protect that

tablecloth we have a place now on top of

that you could think of the placemat as

the preceptor fat pads and on top of

that you have the plate which you can

think of as the orbital membrane on top

of that you have your first layer of

bread which is the Retro orbicularis

oculi fat pad on top of that you may

have the meat the muscle on top of that

is where we try and put our ketchup and

one layer on top of that is the dermis

so actually the ketchup is shielded from

the tablecloth by multiple different

layers and it's exactly like that with

injecting botuline toxin we're actually

injecting tiny amounts just on top of

the muscle and we have multiple other

layers shielding those important

structures in the orbit and it's the

depth of injection rather other than the

position relative to the eyelid that

keeps those internal structures safe

another question that we got many times

was how many units do I like to place in

the dots underneath the eyebrow I find

it really helpful using just a one unit

dose and this is enough to get a

difference I'm not necessarily trying to

paralyze the bulk of the muscle I just

want to affect those fibers that are

pulling the eyebrow down this is also a

safer amount it's a bit like to go back

to our analogy like using less ketchup

you just like less likely to get an

inadvertent mess so small amounts

wherever you can use them are always

safer as a general rule of thumb the

dose response curve is less likely to

cause you a problem so that's why I use

one units and I typically use one to

three units underneath the brow and then

I'll use my stronger doses where the

license dose is higher at the lateral

canthus in terms of dilution I usually

use the standard dilution of 2.5 mils in

100 units of botuline toxin but

sometimes I'll use a more concentrated

form if I'm in an area where I just want

to make sure there's less chance of a

spread but I used to do that a lot more

than I do these days I've had so few

complications that I I very rarely use

different doses when I do use the more

concentrated version it's in the lower

face injecting the depressor angularis

orus or the mentalis I feel safer using

a more concentrated dose for most the

rest of the face I dilute 100 units with

2.5 mils of bacteriostatic saline

another question we got was does the

brow lifter curve from injecting below

the eyebrow or also from injecting above

the eyebrow and in fact years ago I had

patients who would come and say no I

I've had an eyebrow lift and the pain

the doctor injected here you have to do

the same in order to get a lift now if

you think about the anatomy this is this

cannot be true because these are the

elevators and if you inject the elevator

of the eyebrow you're going to decrease

the power of that muscle to lift so

you're actually more likely to get a

drop and in fact most of us are very

afraid of injecting directly above the

eyebrow in the frontalis muscle because

that is where you lose the eyebrow arch

so you only get a lift when you affect

the little tug of war that's going on

with the eyebrow between the two muscles

one's an elevator one's a depressor so

if we weaken the depressor which is the

orbicularis oculi muscle and you can see

this because when you if you want to

lower your eyebrow shut your eyes very

tightly and you will see your eyebrow

comes down and that's caused by

orbicular succuli and the frontalis

muscle does the opposite so the tug of

war is one by reducing the strength of

the depressor which is orbicular circuli

not by treating the frontalis muscle

above it however the other way we create

eyebrow lifts is by increasing the

resting tone of the lateral frontalis

muscle and this is done when we treat

the middle of the frontalis and the

lateral gets more active

so in some of my videos you'll see that

I draw catty as we call them and I tell

injectors generally not to inject in

those cat ears now those cat ears

represent the elevating part of the

frontalis muscle so it's when I say that

it reduces the chance of a ptosis I'm

talking about a brow ptosis not an

eyelidosis and this is one of the

biggest confusions that happens earlier

on for people is differentiating between

a drop in the eyebrow and a drop in the

eyelid and nearly all of the cases I get

Center actually drops in the eyebrow not

in the eyelid the actual eyelid is

stable but it's rested on by a heavy

eyebrow typically if they have extra fat

above their eyes and that's resting or

they have an eyelid shape that just

naturally transmits energy into the

eyelid it confuses injectors but that is

all to do is reducing the strength of

the frontalis muscle in this crucial

area that elevates your eyebrow

laterally so the more botulinum toxin

that you place in this area the more

likely you're going to have that problem

and so particularly in female and not so

much in males I don't treat that area

because I want there to be an eyebrow

arch females also tend to use their

eyebrows in a different way to mend

which is to do with applying makeup

every morning if you apply makeup you

tend to lift your eyebrows up whereas

men do not notice the loss of movement

laterally so you can actually treat men

quite often with more Botox in the cat

ear and weaken the frontalis muscle all

the way across and it does not cause any

problem or concern at all whereas a

female will miss that ability to raise

at their eyebrows and apply makeup other

injectors were concerned by not treating

the cat ear area that you may then cause

a spot Brown and in fact this could be

part of a Spock brow typically I think

of a Spock brow as a medial brow ptosis

and a lateral brow lift so if you over

treat the middle and under treat the

side then absolutely you get this this

disequilibrium and you have too much

activity and too much heaviness in the

middle and that creates this unpleasant

shape so it is possible that you could

be on that Spectrum like everything we

do it you're trying to make the

adjustments to get a happy medium so I

want a little bit of a brow lift not a

huge one and I adjust that sometimes by

putting one unit in the top of that

triangle of the cat ear and that's

typically what I'll do when I know the

patient or when I'm confident that they

have quite a strong frontalis I will

treat within the cat ear area I think

sometimes people see these uh these

markings and they think it's a definite

no-go area it's actually not it's just

an area that I'm more cautious of

injecting and it's helpful if you know

you're creating an eyebrow lift and if

you don't know the patient to start with

leaving it under treated and then to

treat them at a follow-up and then make

a note of where that treatment was so

then you have a plan that will work each

time you see them but the first time you

treat someone particularly if they're a

little bit older and brow drops a little

bit more likely it just makes sense to

see what happens with those units get

the result back in two weeks and then

make an adjustment to learn from it and

then you can repeat safely whatever you

learn from that patient in the first

course of treatment so I hope that's

helped you understand in more detail the

three important muscles particularly

with respect to eyelid drops so we've

got the levator pulpry muscle the

orbicularis oculi muscle and the

frontalis muscle and if you take away

anything from this it's the

three-dimensional injection depth that

matters most in terms of safe injecting

around the eye

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