In a perfect world, we would make every forehead look smooth and feel lifted at the same time, but this does not always happen. A common fear with neuromodulator injections (Botox, Dysport, Xeomin, Jeuveau, Daxxify) is the subsequent sensation of brow or upper eyelid heaviness. Some injectors aim to completely ‘freeze’ the forehead, and while this may make your forehead look beautifully smooth, you may then experience the unfortunate side effect of brow heaviness. The question patients would like answered is: can the side effect of brow heaviness be avoided while still achieving a desirable aesthetic with neuromodulator injections in the frontalis muscle? 

Neuromodulators have the opposite effect on a muscle’s action. If a muscle is meant to lift, injecting a neuromodulator into that muscle will force it to depress. The frontalis muscle (forehead) is the only muscle that elevates your brows. When you relax this muscle (with intention of smoothing your horizontal forehead wrinkles), you are inhibiting your ability to raise your brows which can make the brows or upper eyelids feel heavy.

Certain injection techniques can help prevent the unwanted side effect of brow heaviness. By injecting lower doses into the frontalis muscle and keeping the injections more superior, you can allow for natural movement of the brows without looking too ‘frozen.’ Injections into the orbicularis muscle (crow’s feet) can also help open up the eye and lift the lateral tail of the brow. 

Some patients are not ideal candidates for frontalis neuromodulator injections. If you have very low set eyebrows and/or moderate-severe excess skin/wrinkling of your upper eyelids, the frontalis injections may not be right for you. A lighter dose in the frontalis and a neuromodulator brow lift can be an option for these patients, but a lower dose may not completely smooth the forehead wrinkles. Another option for these patients is to treat the glabella or area between your brows which can help soften the eleven lines. Appropriate injection into this area will not drop the brows. If you think you may not be a great candidate for neuromodulator injections, consult with your provider before proceeding with the injections.

There is a delicate balancing act when injecting neuromodulators. Trust your licensed provider to find the right combination of treatments for you. Sometimes it will take two treatments to get the dose correct, but after finding the perfect amount, that same treatment can be repeated every three to four months for consistent results.