title: Cosmetic Microdroplet Botulinum Toxin A Forehead Lift: A New Treatment Paradigm.
abstract: OBJECTIVE
  To investigate the safety and efficacy of a microdroplet, cosmetic, periocular botulinum toxin A method that extensively treats the eyebrow depressors but leaves the brow elevators untreated.
  
  
  METHODS
  This is a 5-year retrospective, consecutive, nonrandomized series of botulinum toxin treatments. The study was reviewed by an institutional review board and complied with the Health Insurance Portability and Accountability Act (HIPAA). Patients were treated with 33 U onabotulinum toxin (BOTOX, Allergan, Inc., Irvine, CA, U.S.A.) injected in microdroplets of 10 to 20 μl. Sixty to 100 injections of microdroplets were needed to complete a treatment pattern concentrated at the brow, glabella, and crows feet area. The forehead was not treated. Patients who returned between 10 and 45 days were studied with image analysis.
  
  
  RESULTS
  There were 563 consecutive microdroplet treatments on 227 unique patients (female, n = 175, mean age 46 ± 4 years; male, n = 52, mean age 44 ± 8 years). The incidence of ptosis was 0.2% and transient. Forty-nine patients returned for a follow-up visit between 10 and 45 days and were included for image analysis to compare the before and after results of treatment. The average brow height was 24.6 mm before and 25 mm after treatment (p = 0.02). Photonumeric scales for forehead lines, brow ptosis, and brow furrow all showed statistically significant improvements (p < 0.0001).
  
  
  CONCLUSIONS
  The microdroplet brow lift method safely concentrates cosmetic botulinum toxin treatment along the eyebrow, crows feet, and glabellar area, resulting in a brow lift effect that reduces forehead lines, elevates the eyebrow, and reduces the furrow along the brow. This new treatment paradigm results in an aesthetic improvement to the face and periocular area without the forehead paralysis associated with conventional treatment.
authors.affiliation: *The Division of Ophthalmic Plastic and Orbital Surgery, Jules Stein Eye Institute, David Geffen School of Medicine at UCLA, Los Angeles, California; and †Scheie Eye Institute, Department of Ophthalmology, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A.
authors.forename: Kenneth D
authors.initials: KD
authors.lastname: Steinsapir
authors.forename: Daniel
authors.initials: D
authors.lastname: Rootman
authors.forename: Allan
authors.initials: A
authors.lastname: Wulc
authors.forename: Catherine
authors.initials: C
authors.lastname: Hwang
mesh_terms: D065087:Acetylcholine Release Inhibitors / Q000008:administration & dosage*; D000328:Adult; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage*; D003357:Cosmetic Techniques; D005138:Eyebrows; D005260:Female; D005546:Forehead; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015361:Rhytidoplasty / Q000379:methods*; D015595:Skin Aging / Q000187:drug effects*
chemical_list: D065087:Acetylcholine Release Inhibitors; D019274:Botulinum Toxins, Type A