Tutorial: 3D Anatomy Botox (Botulinum Toxin) Brow Lift

We could be accused of being repetitive, but we cannot say is enough…anatomy knowledge is VITAL if you want to be a great aesthetic clinician.

In this blog, Dr Tim Pearce discusses his technique for performing a Botox® (botulinum toxin) brow lift on a patient. Watch Dr Tim’s full tutorial video demonstrating a 3D Botox Brow Lift to see how the 3D models highlighted alongside can help you learn the anatomy and determine accurate injection points.

If you are interested in learning more about facial anatomy to become a great injector and find your route to safer delivery and millimetre precision, get signed up for the Ultimate 3D Anatomy Experience from Dr Tim Pearce.

Medical professionals are taught anatomy in 2D textbooks, but in real life, anatomy is not flat. This educational opportunity is specifically for aesthetic injectors to help you level up your anatomy knowledge, get comfortable with anatomical variations, and boost your injection safety and confidence in a way that no cadaver course could ever deliver.

Get on the waiting list for updates when the Ultimate 3D Anatomy Experience goes live this summer.

Injections underneath the brow

Dr Tim is using Botox or botulinum toxin to achieve a brow lift and starts with the less routine injections using three injection points underneath the brow line which must be superficial. He advises that it might be a little bit safer if you angle your needle slightly away from the eye until you are confident with your anatomical understanding. You are aiming to be underneath the dermis – remember that the dermis is very thin in this location – hence the depth is approximately 0.2mm and it should not be a deep injection.

Once the needle punctures the skin, elevate the skin so you can see a little bit of blanching – this is a good sign and shows you are in the right place – and deliver one unit of Botox in the first (medial) injection point, and across the other two injection points, working laterally towards the end of the brow.

A top tip from Dr Tim (certainly something that makes him feel safer when placing these tiny doses of Botox under the eyebrow, despite admitting no empirical evidence) is to apply a little pressure to the injection points and roll your fingers upwards away from the eye.

You can repeat the same injections on the other side of the face.

Check out additional advice from Dr Tim on how to inject Botox under the eyebrow for a brow lift.

Injections around the eye

When placing his next two-unit Botox injection at the lower of the injection points for lateral canthal lines (crow’s feet) to reduce the downward pull of orbicularis oris, Dr Tim notes that there is much debate about whether you should be pointing the needle away from, or towards the eye.

He notes that certainly when you first start in aesthetic practice, it can be a sensible best practice policy to be pointing away from the eye because it gives you a bit more leeway if you make a mistake.

If you are pointing towards the eye and go too deep, (even if you then retract the needle more superficially before you inject), you can inadvertently create a path or track for the botulinum toxin to disperse where you do not want it to go, creating a side effect. It therefore makes more sense to inject in a direction that would avoid this, even if you place the needle too deeply, i.e., it would be in the direction of the temple and unlikely to cause an issue. If it helps, you can stand on the other side of the bed/treatment couch and lean over your patient to maintain your direction of approach.

Injections into the glabella

Treating the glabella carries a risk of eyelid ptosis, warns Dr Tim. One simple step, he recommends, is using orbital pressure. Squeeze the tissue, applying a little pressure, where the track would have to be for botulinum toxin to get into the orbit.

Remind yourself of the anatomy – the bone is the origin of the corrugator supercilii muscle which is heading towards the insertion point in the eyebrow at the mid-pupillary position. Dr Tim explains that your needle should follow the muscle, meaning you choose the easiest way to be accurate by aiming for the largest shape (the bulk of the muscle). If you aim your needle from an inferior or superior position, you have a smaller area to accurately hit. Using a more lateral approach, along the muscle line, is much safer because if you are a degree or two off, the muscle is still going to capture it.

This is a relatively deep injection to start with, with four units of Botox, whilst placing pressure on the globe. Follow this path along the muscle with additional lateral injections – the next one is three units at intermediate depth (not as deep as the first), and then a superficial injection of one unit. You can again choose to roll the area away from the eye with a final application of pressure along the treated area. You can repeat the same injections on the other side of the face.

Read up on:

• Eye anatomy and how to prevent eyelid ptosis from Botox®
• How to identify and fix eyelid ptosis caused by Botox injections

Injections into the forehead

Dr Tim believes that forehead injections are, technically speaking, the easiest because so much time is spent marking out to create a safety margin that this is where the real skill lies and not in delivering the injections themselves.

However, that is not to say that the injections are not important and that they cannot be done incorrectly. If you inject intradermally and see small, white blebs that form as the botulinum toxin is placed, your patient will not get a result that is as effective as it should be. You will have botulinum toxin sitting in the dermis, not the muscle – reflect on your anatomy knowledge – underneath the dermis is the hypodermis (a layer of fat), and then the muscle fascia and the muscle you are trying to treat – being in the dermis, you are separating the neurotoxin away from the effective area.

Dr Tim’s methodology is to take his needle through the dermis where you will feel resistance that suddenly eases and proceed a tiny bit more through the muscle fascia (where all the nerve endings are located) and into the muscle to inject. He notes that if you go deeper and touch the bone, this is not the end of the world, but it will probably blunt your needle every time you touch the periosteum, and your patient may or may not feel additional discomfort.

Use a 45° angle of entry, through the resistance of the dermis, into the muscle, and place two units of Botox in your marked areas on the frontalis muscle. The final doses of one unit are placed near the hairline.

For additional guidance on botulinum toxin injection points, including brow lifts, download Dr Tim Pearce’s 26 essential injection patterns for botulinum toxin and read up on the best tried and tested BOTOX® injection patterns and mistakes to avoid and the best Botox brow lift injection patterns to avoid ptosis and Spock brow.

Wipe any blood spots away from the injection sites quickly before they dry and become much harder to remove – saving you clinic time and avoiding additional patient discomfort. If you should hit any small veins whilst injecting, which continue to bleed, do not be tempted to keep checking to see if the bleeding has stopped. Dr Tim’s top tip – which should help to reduce the likelihood of even minor bruising, which your patient will thank you for – is to hold on to the spot for a full minute and wait for the natural resolution.

You can also find Dr Tim Pearce on Instagram if you have any tips to share, case studies to discuss, or questions for him.

If you want to learn more in-depth 3D anatomy knowledge, better than a textbook or a cadaver course, make sure you get on the waiting list for Dr Tim Pearce’s Ultimate 3D Anatomy Experience.

Botox® is a registered trademark of Allergan Aesthetics plc.

Aesthetics Mastery Show

3D Botox brow lift injection tutorial

Dr Tim says:

“In this tutorial I demonstrate my technique for how to perform a Botox Brow Lift on a patient. The 3D models shown on screen help me to learn the anatomy & determine accurate injection points.”

Watch the full Aesthetics Mastery Show here.

This episode has over 30 comments already including feedback from clients/patients as well as practitioners.

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BOTOX (Botulinum Toxin) eLearning Courses

If you want to increase your confidence in botulinum toxin injections, or learn how to avoid and handle complications, Dr Tim Pearce offers two comprehensive courses that are highly rated by our delegates:

• BOTOX® Foundation Course
• Botulinum Toxin Complications Mastery

Both give CPD and certificates on completion.

In addition, browse our FREE downloadable resources on complications.

3D anatomy learning experience movement

In the next few weeks, Dr Tim Pearce is going to be launching something amazing that involves an incredible 3D learning experience for injectors, a community of clinicians on the same mission as you to help you achieve your goals, and exclusive online access to him and his team, to help you become a pro injector. Be the first to join the movement by joining the priority waiting list.

Botox® is a registered trademark of Allergan Aesthetics plc.

Dr Tim Pearce eLearning

Dr Tim Pearce MBChB BSc (Hons) MRCGP founded his eLearning concept in 2016 in order to provide readily accessible BOTOX® and dermal filler online courses for fellow Medical Aesthetics practitioners. His objective was to raise standards within the industry – a principle which remains just as relevant today.

Our exclusive video-led courses are designed to build confidence, knowledge and technique at every stage, working from foundation level to advanced treatments and management of complications.

Thousands of delegates have benefited from the courses and we’re highly rated on Trustpilot. For more information or to discuss which course is right for you, please get in touch with our friendly team.