Frontalis botox

Question 1

What is the SE line of the frontalis?

How do you identify it?

How do you prevent brow ptosis?

Answer 1

SE line is the line of convergence where the frontalis muscle moves in two opposite directions.

Above the SE line-moves downwards
Below the SE line-moves upwards

Question 2

Harley academy’s technique
Identify the 5 points for injection of the frontalis muscle

Answer 2

Question 3

Injection technique:

At what angle should you inject Botox into frontalis muscle? How many mm deep to prevent pain in periosteum?

How do you prevent brow ptosis? How many cm above the superior orbital rim should you inject?

How many units of Botox per injection point?
In total, how many units should be used (lower to max) for natural results?
If you are unsure of how many units to inject, what should you do?

Update with Dr Tim Pearce’s technique

Answer 3

Subcutaneous injection; 1/3 tip of needle
45-60 degree angle for proper injection
2-3mm deep.

Injections of frontalis should be in upper half not lower half to prevent brow ptosis. 2.5cm above superior orbital rim. Brow ptosis can occur if too many units placed laterally

1-4 units of Botox per injection point. 0.025ml-0.1ml. 2 units for natural result
12 to 20 units in total
If you are unsure, inject less and take a picture of injection points. Follow up with next visit

Update with Dr Tim Pearce’s technique:
Inject 1 unit with more injection points, spread at least 1.5-2cm apart. Drawing points evenly is important for even distribution. Injecting 1 unit is more forgiving.

Question 4

Complications of frontalis botox
A 30 year old woman complains of difficulty applying makeup after her botox to her forehead frown lines. You notice drooping of her eyebrows

Explain what has happened?
How do you avoid this?
How many cm from superior orbital rim do you have to inject?

Management
How do you correct brow ptosis from frontalis botox?
How long does it take to resolve?
What eye drops can help with this?

Prevention
what injection techniques can be used to prevent this from happening?

Answer 4

Question 5

Complications of frontalis botox
What are Spock eyebrows/mephisto and their causes?

A Under treatment of the lateral frontalis muscle fibres.

B Over treatment of the lateral frontal muscle fibres.

Q4 How do you correct a Spock?
A You can’t – you need to wait for the toxin to wear off.

B Inject 1-2 units of botox to the active lateral frontalis.

Answer 5

A Under treatment of the lateral frontalis muscle fibres.

Spock eyebrows occur when the lateral frontalis is undertreated compared to the central frontalis

To prevent this:
- injection points should extend to 1cm medial to lateral temporal crest

Correction of spock:
- Inject 1-2 units of botox to the active lateral frontalis.

Question 6

Biomechanics
Why can’t you treat the frontalis alone without glabella botox? What will isolated frontalis treatment result in?

Why can you treat the glabella alone without frontalis botox?

Answer 6

Question 7

Answer 7

false
bilateral brow ptosis from frontalis treatment without glabella treatment-> brow depression-> ptosis

Question 8

-what causes central brow ptosis and how do you correct this?
-what causes lateral brow ptosis and how do you correct this?
-if vision is restricted due to brow ptosis, what can be done?

Answer 8

medial brow ptosis-> corrected with treatment of medial corrugator in 2-4 weeks