The Impact of Botulinum Toxin on Brow Height and Morphology: A Randomized Controlled Trial

Phase 4

Interventions: Drug: Dysport
Procedure: lateral orbicularis injection
Procedure: Lateral orbicularis + corrugator injection

Brief Summary: The purpose of this study is to describe three safe and reproducible techniques for brow lifting using botulinum toxin. It will also describe the effect of 2 techniques on the eyebrow shape using quantitative, objective measurements and satisfaction scales.

Recruitment & Eligibility

Inclusion Criteria

Consecutive 30 female patients presenting to our clinic for brow lifting with botulinum toxin will be randomized to receive one of the two injection techniques

Exclusion Criteria

Patients with previous periorbital/forehead surgery
Patients who plucked the upper eyebrow margin
Patients with eyebrow tatoos
Patients with upper face botulinum toxin injection in the past 12 months
Patients with resorbable upper face fillers injection in the past 12 months
Patients with previous permanent upper face fillers injection
Pregnant patients
Lactating patients
Patients with preexisting neuromuscular conditions (myasthenia gravis, Eaton Lambert syndrome)
Patients using medication that could potentiate the effect of botulinum (ex: aminoglycoside antibiotics)
Patients with sensitivity to botulinum toxin or human albumin

Arm && Interventions

Group	Intervention	Description
Technique 1: Lateral orbicularis injections	lateral orbicularis injection	5 equally spaced injections will be placed intramuscularly into the orbicularis under the lateral eyebrow starting lateral to the level of the lateral limbus and extending to the level of the inferior orbital rim.
2. Technique 2: Lateral orbicularis and Corrugator injections	Lateral orbicularis + corrugator injection	5 equally spaced injections will be placed intramuscularly into the orbicularis under the lateral eyebrow starting lateral to the level of the lateral limbus and extending to the level of the inferior orbital rim. In addition, 2 injections will be placed into the corrugator at the medial brow
Technique 1: Lateral orbicularis injections	Dysport	5 equally spaced injections will be placed intramuscularly into the orbicularis under the lateral eyebrow starting lateral to the level of the lateral limbus and extending to the level of the inferior orbital rim.
2. Technique 2: Lateral orbicularis and Corrugator injections	Dysport	5 equally spaced injections will be placed intramuscularly into the orbicularis under the lateral eyebrow starting lateral to the level of the lateral limbus and extending to the level of the inferior orbital rim. In addition, 2 injections will be placed into the corrugator at the medial brow

Primary Outcome Measures

Name	Time	Method
Objective assessment	15 days post treatment	Objective assessment will be done on anteroposterior views of pre-and-post injection photographs. The mid pupillary line will be drawn and the eyebrow vertical height will be measured from this line to the upper border of the brow at seven horizontal points: the most medial aspect of the eyebrow, medial canthus, medial limbus, mid pupil, lateral limbus, lateral sclera, and most lateral eyebrow.

Secondary Outcome Measures

Name	Time	Method
Patient satisfaction	15 days post treatment	Patient satisfaction will be determined by a questionnaire completed at 15 days post-treatment. Subjects will indicate how satisfied they are on a 4-point scale (1-4) as follow: 1. Very Satisfied 2. Satisfied 3. Dissatisfied 4. Very Dissatisfied.

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