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Injecting Botulinum Toxin at Different Depths Is Not Effective for the Correction of Eyebrow Asymmetry

Sneath, Jason MD*; Humphrey, Shannon MD*; Carruthers, Alastair MD, FRCPC, FAAD*; Carruthers, Jean MD, FRCSC

doi: 10.1097/DSS.0000000000000159
Original Article

BACKGROUND It is theorized that brow elevation after treatment with botulinum toxin Type A (BoNT-A) results from inactivation of the brow depressors. Expert consensus is that increased injection depth delivers more BoNT-A to these depressors and causes increased elevation. This technique is applied to the correction of brow height asymmetry.

OBJECTIVE To compare changes in brow height after deep versus shallow BoNT-A in patients with brow asymmetry.

METHODS A prospective split-face analysis was performed on 23 women with eyebrow-height asymmetry. Subjects received 64 units of BoNT-A, divided among 16 injection sites in the glabella, forehead, and lateral canthal area. On the side where increased brow lift was desired, deep injections were performed and shallow injections on the opposite side. Photographs were taken at baseline and Week 4 for comparison measurements.

RESULTS All 23 women enrolled completed baseline injections and returned for the 4-week follow-up. There was no significant difference at 4 weeks in the change in brow height between the sides that received deep versus shallow BoNT-A injection.

CONCLUSION Because of the diffusion of the BoNT-A between muscle layers, the eyebrow depressor muscles cannot be accurately targeted with deep injection into the muscle belly for correction of eyebrow height discrepancies.

Departments of *Dermatology and Skin Science, and

Ophthalmology, University of British Columbia, Vancouver, BC, Canada

Address correspondence and reprint requests to: Jason R. Sneath, MD, 835 West 10th Avenue, Vancouver, BC V5Z 4E8, Canada, or e-mail:

Supported by Allergan, funds included the vials of Botox and financed Canfield measuring the eyebrow height.

The authors have indicated no significant interest with commercial supporters.

© 2015 by the American Society for Dermatologic Surgery, Inc. Published by Lippincott Williams & Wilkins
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