“The Impact of Upper Face Botulinum Toxin Injections on Eyebrow Height and Forehead Lines: A Randomized Controlled Trial and an Algorithmic Approach to Forehead Injection”

Background: No previous study has objectively evaluated the effect of different forehead injection patterns on the eyebrow height and forehead lines. Methods: The patients were divided into three groups. Botulinum toxin was injected in both the lateral and medial eyebrow depressors in all groups. The frontalis was injected using either a V-pattern (group1), a middle horizontal pattern (group 2) or a high horizontal pattern (group 3). Objective eyebrow measurements were performed using standardized pre-and- post injection photographs. Validated photonumeric scales were used to assess the forehead lines. Results: 15 patients (30 eyebrows) were included in each group. In all the groups, 2 weeks after the injection, the brow was lower at all the measured positions in the exception of the lateral brow edge that was higher in the 3 injection patterns. No difference was found when comparing group 1 to groups 2 and 3. The middle forehead injection pattern lowered the eyebrow more than the upper forehead injection pattern. The 3 techniques improved the forehead lines at rest and with contraction. The forehead lines with contraction were more improved in group 1 when compared to both groups 2 and 3. Conclusion: Each forehead injection pattern yielded different results on forehead lines and eyebrow position. Upper forehead injections were less effective on forehead lines but prevented eyebrow ptosis. Financial Disclosure Statement: All the authors have nothing to disclose. No funding was received for the article. List of product used: Dysport© (Ipsen Ltd, Berks, UK) Ethical approval was obtained from the institutional review board of Hotel Dieu de France Hospital, Beirut, Lebanon. All participating patients gave informed written consent. Clinical trial registration information: Name of trial database: ClinicalTrials.gov Registration number: NCT03186001 URL: https://ift.tt/2P4J7TC Corresponding author: Samer Jabbour, MD, Faculty of Medicine Saint-Joseph University Hotel Dieu de France Hospital, Alfred Naccash boulevard, samermed@gmail.Com ©2018American Society of Plastic Surgeons