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• Indications

Hyperactivity of the lateral orbicularis oculi muscle can pull down on the lateral aspect of the brow. The orbicularis oculi muscle pulls down on the tail of the brow and opposes the lifting action of the fron­talis muscle.

• Anatomic Considerations

The orbicularis oculi muscle is a strong brow depressor. The superolateral orbicularis oculi is posi­tioned at or just inferior to the level of the hair of the lateral eyebrows.

• Injection Technique

The non-injecting hand should be used to raise up the brow, and injections should be kept 1 cm above the eye socket rim. Topi­cal anesthesia is not necessary.

Botox should be 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.

• Precautions

Bruising is a risk in the brow area. The peri­ocular area has many superficial veins, which may be visible through the surface of the skin. Injecting into the superficial subcutaneous tissue minimizes bruising.

• Post-Injection Instructions

Firm pressure should be applied. Bruising is more likely in this area..

• Risks

Botox may paralyze the levator palpebrae su­perioris muscle.

• Pearls of Injection

Some patients will not be able to achieve significant brow elevation.

Brow elevation results from the upward pull of the brow by the frontalis muscle; therefore, simultaneous in­jection of the lateral aspect of the frontalis and the lateral orbicularis muscles will counteract the upward lift of the brow in this region.

Fig. Suggested Botox injection patterns of the lateral aspect of the orbicularis muscle, which can result in a lateral brow lift.