How do you assess the forehead to avoid brow ptosis / heavy brows?
Two of my forehead patients felt 'heavy' at review. I clearly need a better assessment before I inject frontalis. What are you actually looking at in the consult?
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Brow heaviness after frontalis is almost always an assessment issue, not an injection-skill issue. Before you treat the forehead: 1. Remember the frontalis is the ONLY brow elevator. If you weaken it, whatever the depressors (glabellar complex + lateral orbicularis) do is now unopposed. 2. Ask the patient to relax, then raise the brows — watch how much they recruit frontalis at rest. Patients who use their forehead to hold up heavy or hooded brows are high-risk for feeling heavy afterwards. 3. Look at resting brow position and any pre-existing lid hooding/dermatochalasis. Older patients and those with brow ptosis often do better with a lighter touch or forehead avoided. 4. Keep injections in the upper forehead, treat the glabella at the same time, and under-dose on the first visit — review at two weeks and top up if the brow can take it. Managing expectations at the consult ('we soften, not freeze, and I'd rather add at review than leave you heavy') prevents most complaints.
- Priya Sharma, RN★ 38
The 'ask them to relax then look at how much frontalis they're using at rest' tip is gold. Some patients are basically holding their eyebrows up with their forehead all day.
No reactions yet - Asher ★ 0
I now photograph brow-up and brow-relaxed at every forehead consult. Makes the two-week review conversation much easier if anything shifts.
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