Forehead Movement Discrepancies After Botulinum Toxin Injections: A Review of Etiology, Correction, and Prevention

Abstract

BACKGROUND Forehead rhytides are a popular target for botulinum toxin injections, but neuromodulation of the frontalis can be fraught with complications because of its anatomic complexity and integral role in brow position and expressivity. OBJECTIVE This article explores common forehead movement discrepancies that can occur after neuromodulation of the frontalis, as well as how to correct and prevent them. METHODS A review of the literature was conducted and combined with clinical experience to examine underlying forehead anatomy, etiology and correction of forehead movement discrepancies, and important factors to consider before injecting the frontalis with botulinum toxin. RESULTS AND CONCLUSION Variable anatomy from person to person necessitates an individualized treatment approach to achieve the best cosmetic results and prevent the occurrence of forehead movement discrepancies.

Optimizing Botulinum Toxin A Administration for Forehead Wrinkles: Introducing the Lines and Dots (LADs) Technique and a Predictive Dosage Model

“…Measurements indicate a gradual lateral reduction in frontalis muscle thickness from approximately 1.80 mm, identified at the intersection of the pupil’s midline with the horizontal plane connecting the metopion and glabella, to about 1.61 mm at the juncture aligned with the lateral canthus. Further laterally, at the convergence with the line from the lateral orbital rim and the aforementioned horizontal plane, the thickness diminishes to a mere 0.11 mm [ 46 , 47 , 48 ]. One study identifies that motor endplates, essential for motor function, are predominantly located in the middle and upper portion of the frontalis [ 35 ].…”