Table 51.1
Indications for treatment
| Horizontal forehead rhytids that worsen with eyebrow elevation |
| Lack of underlying brow ptosis, eyelid ptosis, or upper eyelid dermatochalasis |
Table 51.2
Preoperative evaluation
| Rule out underlying brow ptosis |
| Rule out underlying upper eyelid ptosis or upper eyelid dermatochalasis |
| Excessively deep rhytids may require additional treatment with dermal fillers or laser skin resurfacing |
Introduction
The forehead is an off-label indication for all the FDA-approved brands of botulinum toxin type A. The forehead requires caution in treatment, as overtreatment in this area can lead to several undesirable outcomes. It is advisable to treat this area conservatively and have patients return for additional treatment if necessary. Particular caution must be taken not to treat patients whose rhytids are due to compensation for underlying brow ptosis, eyelid ptosis, or upper eyelid dermatochalasis.
Surgical Technique
Preoperative evaluation at rest
Without frontalis muscle activity, this patient has no horizontal forehead rhytids and she demonstrates no brow ptosis, upper eyelid ptosis, or upper eyelid dermatochalasis ( Figure 51.1 ). She is, therefore, an excellent candidate for botulinum toxin treatment of her frontalis muscle.
