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News & Press: Annual Meeting

Microdroplet Botulinum Toxin Treatment Along Browline Eases Wrinkles Without “Frozen Forehead” Look

Saturday, February 11, 2017  
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OFFICIAL NEWS RELEASE FROM THE AACS 2017 Annual Scientific Meeting

Kenneth D. Steinsapir, MDSAN DIEGO – Injecting microdroplets of botulinum toxin A along the eyebrow reduces forehead wrinkles without the frozen-forehead look common after standard botulinum toxin treatment, suggests research being presented here today at the American Academy of Cosmetic Surgery Annual Scientific Meeting.

Standard treatment involves injecting botulinum toxin directly into the forehead, smoothing the brow but preventing the patient from making natural expressions. Often the result is an unnatural, frozen look. With the microdroplet technique, treatment is concentrated along the eyebrow area using microdroplet injections, avoiding the forehead altogether. 

“The microdroplet technique relaxes the muscles that pull the brow down and make the resting brow pinch,” said Kenneth D. Steinsapir, MD, inventor of the technique and associate clinical professor of ophthalmology at Stein Eye Institute, David Geffen School of Medicine at UCLA. “Because the forehead is left untreated, the result is a natural brow lift with reduced or absent forehead lines but normal forehead movement.”

Dr. Steinsapir is reporting on 563 consecutive microdroplet lift treatments with BOTOX®, one of several brands of botulinum toxin A, in 227 patients during a five-year period. In-person follow-up was conducted for 256 cases (45 percent) and phone follow-up for 60 cases (11 percent). There was no follow-up for the remaining 247 treatments. Among patients with follow-up, the reported incidence of a side effect called ptosis, or eyelid droop, was .2 percent and was temporary. This is significantly less than the 2 percent to 4 percent reported with standard treatment. 

Forty nine patients (22 percent) who returned for a visit 10 to 45 days after initial treatment were included in a before-and-after analysis. Three physicians not involved in the treatment graded before and after images of the patients using three scales to measure brow positioning, forehead lines and brow furrow. All demonstrated statistically significant improvement after microdroplet treatment.

  • The Merz Brow Positioning Scale rates appearance from 0 (youthful, refreshed look with high arch eyebrow) to 4 (flat eyebrow with barely any arch; marked visibility of folds; very tired appearance). Overall, the physicians rated patients 2 before treatment and 1.6 afterward.
  • The Merz Forehead Line Scale rates appearance from 0 (no lines) to 4 (very severe lines). Overall, the physicians rated patients 1.2 before treatment and .8 afterwards.
  • The Brow Furrow Scale, developed by Dr. Steinsapir for this study, rates appearance from 0 (youthful, relaxed brow) to 4 (tense brow with furrows and muscle volume). Overall, physicians rated the patients 1.7 before treatment and 1 afterward. 

Botulinum toxin removes or lessens wrinkles by temporarily paralyzing the muscles in the face. The effects last four to six months and then the treatment typically is repeated. Standard treatment involves about 20 to 30 injections of .1 ml botulinum toxin in the forehead, between the eyes (glabella) and on the outer edges of the eyes (crow’s feet area). The treatment involves 60 to 100 injections of .01 ml of botulinum toxin (one-tenth the amount typically injected) along the entire brow, glabellar and crow’s feet areas.  

In standard treatment, larger amounts of botulinum toxin are injected deeper into the muscle and can spread outside the intended treatment area. In the new technique, the small microdroplets of botulinum toxin are injected at a controlled depth between the skin and muscles of facial expression that insert into the skin. As a result, the botulinum toxin is less likely to spread outside the intended area and cause side effects such as eyelid droop, Dr. Steinsapir said.

“The resting brow pinch is softened. There is a gentle, natural lift to the eyebrow because the forehead muscle is not working against the muscles that pull the eyebrows down,” said Dr. Steinsapir. “Forehead lines diminish or disappear.” 

Because the technique is not considered health-related, it is usually not covered by insurance. While the cost varies depending on the doctor, consumers can expect to pay a premium for the service because it is more detailed and requires more injector time than standard treatment with botulinum toxin.

About the American Academy of Cosmetic Surgery
Founded in 1985, the mission of the American Academy of Cosmetic Surgery is to advance the specialty of cosmetic surgery and quality patient care. AACS is the leader in continuing medical education for all specialties of cosmetic surgery, providing fellowship training programs, live surgery workshops, medical symposiums and an Annual Scientific Meeting. Most members of the AACS are board‐certified cosmetic surgeons, dermatological surgeons, plastic and reconstructive surgeons, head and neck surgeons, oral and maxillofacial surgeons, obstetric‐gynecologic surgeons, general surgeons and ophthalmic surgeons – all of whom specialize in cosmetic surgery. AACS is the organization that represents all cosmetic surgeons in the American Medical Association through its seat in the AMA House of Delegates.