Preoperative Botulinum Toxin for Endoscopic Brow Lifting

Abstract

Administration of botulinum toxin into the depressor muscles of the brow can produce a mild brow lift. When administered 2–3 weeks prior to a brow lift, the lack of activity in these muscles allows the brow to heal in it newly elevated position with less downward stress on the tissues. Consistent postoperative use of botulinum toxin is beneficial for prolonging the results of a brow lift.

Preparing a patient for an endoscopic brow lift is an excellent time to introduce the benefits of botulinum toxin. Over time, constant use of the brow depressor muscles (corrugator, procerus, and lateral orbicularis muscles) has worked with gravity to lower the brow to its current position. Temporary paralysis of these muscles allows the elevator muscles of the brow to work without counterbalance, thus making them relatively stronger.

In a borderline low brow, botulinum toxin may make enough of a difference to postpone a brow lift for several years. In a truly low brow, this will not make a big difference prior to a brow lift. However, given 2–3 weeks prior to surgery, it will keep the patient from using those muscles to pull down against a freshly lifted brow. This allows the brow to heal with less stress during the first 2–3 months postoperatively. Once the botulinum toxin has worn off, it is up to the patient to decide whether to continue with the botulinum toxin. Encourage continued botulinum toxin at least every 6 months to maintain the results of the brow lift as long as possible.