Forehead (Frontalis Muscle)
The injections should be intra-dermal which is taking a 5-10° angle at the point of needle penetration and breaking the skin. When the needle is below the skin a small amount (typically .05 – 1.0cc) is administered within the soft tissues of the epidermis or dermis (avoiding the periosteum). The areas of the injection for the Frontalis is at least (1) finger breath above the eyebrow and should not extend laterally beyond the frontal limbus. The injection may be painful due to superficial nerves throughout the forehead and visual observation should be used to avoid the (2) large veins of the forehead; supratrochlear vein and supraorbital vein.
Potential Complications:
- Brow Ptosis / Heaviness: This condition occurs where either the injection of the Botulinum Toxin-A was delivered too low (less than one finger breath above the eye brow) or the Glabella Region was not treated at the same time. The Frontalis Muscle is the only elevator muscle in the upper 1/3 of the face – if relaxed and the depressing muscles interacting with the frontalis are not relaxed it is possible for the eyebrow to lower and or feel heavy to the patient. Other possible reasons for this condition could be administering too large an amount (units) of the Botulinum Toxin-A in the area. This is a cosmetic condition and could last the duration of the expected treatment.
