can someone with a lot of botox experience help me? for a post-glabellar injection patient who then develops a small crinkle above the lateral brow but otherwise likes the mr.spock lift, would you do a lateral brow lift of 4-6 units and/or inject 1-2 injects just above the crinkle? Or would full treatment of the forehead area be a safer way to avoid lateral brow ptosis and still effectively get rid of the crinkle even the injections will be much more superior to it? I've also been told the it's difficult to consistently predict how much a lateral lift a patient will get with the lateral brow technique. Anyone finding this to be the case?

When you injected the glabellum, how far lateral did you go? Either of the options you listed will likely benefit the pt. I had this issue when I first started injecting as well and I usually would put a small amount like 2 units into the wrinkle. Make sure to be as symmetrical as possible.

One way to avoid this problem is to go more lateral when injecting the glabellum. Your most lateral injection should be into the lateral corrugator muscle. You can see the lateral portion of the corrugator by having the patient scowl. It inserts into the skin just above the eye. The lateral portion of the corrugator will cause the skin to indent somewhere around the mid-pupillary line. Inject at that spot and try to stay 1 cm above the supra-orbital rim and do not pass the mid-pupillary line though. This should allow the middle portion of the brow to elevate thus eliminating the "spock" brow.

The lateral brow lift is variable and difficult to predict. I use between 2 to 4 units in most cases. You want to stay about 4 to 5 mm lateral to the area of the brow lifted by the frontalis muscle. Ask the patient to raise their brow and you should be able to see where the frontalis muscle inserts into the lateral brow. I would say about 85 to 90% respond and like it. You will see about 2mm of lift in most cases occasionally you will get a little more and occasionally none.

thanks LH for your detailed answer that definitely answers my question.

Is there a new technique of injecting botox in the Nasal Labal Fold (NLF)? One of my patients said another doctor injected her lateral to the lips in the NLF bilaterally.

I'm thinking forget the NLF; this area classically needs filling and not myo-blockade. I've had people that (unfortunately) strayed from us and had unusual muscles of facial expression whacked by Botox and ...well...just had to wait it out. Enough said.

DermaRogue:　If I'm not mistaken, I think that is actually what happened to the Joker.

I would not inject the NLF unless you have a ton of experience. It is high risk for asymmetry and must be the perfect patient. You inject 1 to 3 units into the medial bulge of the NLF next to the nose. You want to stay very superficial.

The ideal candidate is younger with a lot of gum showing when they smile. I have never done this one though. It is high risk and the patient must live with it. I would only do it on long term patients that are well acquainted with Botox.

I found a very good book for advanced botox use. It is "Botulinum Toxin in Aesthetic Medicine" by Mauricio de Maio and Berthold Rzany and published by Springer

I have injected just adjacent to the nose at the top of the NLF solely for the gummy smile (not to actually do anything with the fold). I use 1 unit each side and you can come back in 2 weeks with another unit if you don't get enough gum coverage.