Objective To determine if the medial brow can be elevated following administration of botulinum toxin type A (Botox, Allergan, Irvine, Calif).
Design A before-after interventional study comparing pretreatment and posttreatment brow height. Objective measurements and subjective comparisons of pretreatment and posttreatment slides were made by 7 independent observers unaware of treatment status. All measurements and observations were based on standardized photographs taken with identical lens settings.
Setting Private facial plastic surgery practice. All injections were performed in office examination rooms without anesthesia or sedation.
Patients Thirty adult patients electively seeking improvement of glabellar frown lines or low-positioned medial brows (angry appearance).
Intervention Twenty units of botulinum toxin type A was injected into the corrugator supercilli and procerus muscles. An electromyographic needle was used for the initial 10 injections, and a 30-gauge needle was used for the remainder.
Outcome Measures In the objective arm, change in brow height was measured from the medial canthus and midpupil directly vertical to the brow hairs; the change in interbrow distance was also measured. In the subjective arm, the number of patients who were found to have an elevated medial brow by the independent observers was noted. Objective and subjective findings were correlated.
Results Objective measurements yielded a raise in the medial brow in 8 (32%) of 25 patients from the medial canthus and in 12 (48%) of 25 from the midpupil and an increase in interbrow distance in 17 (59%) of 29 patients. Subjective comparison found 18 (62%) of the 29 patients to have higher medial brows after treatment.
Conclusions Botulinum toxin type A treatment can create a chemical browlift. Further studies with more specific selection criteria are needed to better evaluate this effect.
