What are the recommended injection sites and doses for botulinum toxin (Botox) or Dysport for an eyebrow raise?

Recommended Injection Sites and Doses for Botulinum Toxin Eyebrow Raise

For optimal eyebrow elevation, botulinum toxin should be injected into the lateral aspect of the corrugator supercilii muscle and the procerus muscle, with precise placement being more important than injection depth.

Anatomical Targets and Injection Technique

Primary Injection Sites

• Procerus muscle:

  • 5-10 units of Botox (or 10-20 units of Dysport) injected deep into the midline procerus muscle
  • Placement should be at the bridge of the nose between the eyebrows

• Corrugator supercilii muscles:

  • 5-10 units of Botox (or 10-20 units of Dysport) per side
  • Inject into the superior middle aspect of each corrugator muscle rather than directly above the medial eyebrow head
  • Target the lateral portion of the corrugator between the midpupil and lateral limbus

• Optional lateral canthal area (crow's feet):

  • 5 units of Botox (or 10 units of Dysport) per side
  • Place injections 1-1.5 cm lateral to the orbital rim
  • This helps create a more balanced brow elevation

Precision Considerations

Depth of Injection

• Research indicates that varying injection depth does not significantly affect outcomes for brow asymmetry correction 1
• Focus on precise anatomical placement rather than injection depth

Avoiding Complications

• Critical safety point: Avoid injecting directly above the central pupillary line to prevent ptosis
• Maintain at least 1 cm distance above the orbital rim when injecting
• Injecting the superior middle aspect of the corrugator rather than the belly of the muscle significantly reduces ptosis risk 2

Dosing Guidelines

Standard Dosing

• Total dose range: 20-40 units of Botox (or 40-80 units of Dysport) for full eyebrow treatment
• Start with conservative dosing and adjust in follow-up treatments based on response

Specific Formulation Considerations

• Botulinum toxin products are not interchangeable 3
• Conversion ratio of approximately 1:2-3 between Botox and Dysport (1 unit Botox ≈ 2-3 units Dysport)

Treatment Protocol

1. Mark injection points with patient in upright position
2. Cleanse area with alcohol or antiseptic
3. Administer injections using a 30-32 gauge needle
4. Apply gentle pressure after injection to prevent diffusion
5. Instruct patient to remain upright for 4 hours and avoid touching the area

Expected Outcomes and Follow-up

• Onset of action: 3-7 days
• Peak effect: 2 weeks
• Duration: 3-4 months
• Schedule follow-up at 2 weeks to assess results and make any adjustments

Cautions and Contraindications

• Avoid in patients with neuromuscular disorders
• Use with caution in patients with previous ptosis
• Have epinephrine and antihistamine treatments available during administration 4
• Risks include ptosis, headache, and asymmetry 3

Storage and Handling

• Store reconstituted botulinum toxin at 2-8°C (36-46°F)
• Use within 24 hours of reconstitution
• Do not shake the vial 4

The most aesthetically pleasing outcomes are achieved with precise targeting of the corrugator and procerus muscles while avoiding frontalis muscle injection 5. Careful attention to anatomical landmarks and conservative dosing will help minimize complications while achieving the desired eyebrow elevation.