Indications

Hyperactivity of the lateral aspect of the orbicularis oculi muscle can result in ptosis of the lateral aspect of the brow. Vertically and obliquely oriented fibers of muscle, when activated or with baseline resting muscle tension, pull down on the position of the tail of the brow and oppose the lifting action of the frontalis muscle.

Anatomic Considerations

The orbicularis oculi muscle is a strong brow depressor. In most patients, the superolateral orbicularis oculi is positioned at or just inferior to the level of the lateral eyebrow hairs.

Injection Technique

The best effect occurs when the noninjecting hand is used to elevate the brow and injections are kept approximately 1 cm above the orbital rim. Topical anesthesia may be used but is not necessary in most cases.

BoNTA is injected into the muscle in two to three spots along the lateral brow, each with 2 to 3 BU for a total of 4 to 6 BU per side.