In our clinic, there are cases in which patients who are considering double-overlap surgery are asked to have botulinum toxin injections in the forehead (forehead). This is for patients who have a strong habit of raising their eyebrows and cannot fold the double fold line neatly even after simulation using a bougie.

Botulinum toxin injections (forehead) work to suppress muscle movement in the area of injection. It is commonly used to improve expression wrinkles, such as the vertical crease between the eyebrows or the wrinkles at the corners of the eyes when smiling.

In people who have a strong habit of raising their eyebrows, botulinum toxin injections are used to suppress the eyebrow lifting motion.

Why do people who have a strong habit of raising their eyebrows need to reduce eyebrow movement before surgery?

This is because if the habit of raising the eyebrows is strong, the skin on the eyebrow side will not be covered by the double fold line, so a beautiful double fold will not be created.

People who don't have the habit of raising their eyebrows.

Let's look at an illustration of how a person who does not have the habit of raising his eyebrows can have a double brow.

The double line is drawn back along the eyeball. The skin on the brow side of the double line is then folded and covered by the double line. The width of the double fold, as you call it, is the difference between the length to the double fold line minus the skin covering it (⭐︎).

People who have a strong habit of raising their eyebrows.

Let's look at an illustration of the condition of a person who has a strong habit of raising his eyebrows.

The double line is similarly drawn back along the eyeball. However, due to the habit of raising the eyebrows, the skin on the eyebrow side of the double fold line is not covered by the double fold line. This results in a wide, shallow, and depthless double fold. There is also a risk that the habit of raising the eyebrows will result in the formation of an unscheduled double eyelid line (the so-called triple fold).

If the double line is drawn upward due to the habit of raising the eyebrows, there is also a risk that adhesion of the double line will occur in a wider area than planned.

Because the eye opening is temporarily worsened by swelling after bifurcation surgery, even those who thought their eyebrow-raising habit was mild before the surgery may have a strong tendency to raise their eyebrows afterward.

Botulinum toxin injection (forehead)

Usually, botulinum toxin injections are given prior to surgery, but in some cases, depending on the situation, botulinum toxin injections may be requested after surgery.

Botulinum toxin injections in the forehead are performed preoperatively, but are not requested for everyone who has a habit of raising their eyebrows. The cause of the habit of raising the eyebrows should be considered.

Most people who have a unibrow and a large amount of skin covering the dark eye have a habit of raising their eyebrows. However, if the habit of raising the eyebrows is not so strong, the position of the eyebrows will often drop with a double fold. We do not ask for preoperative botulinum toxin injections (forehead) for those who expect that their eyebrows will naturally lower with a double fold.

For some people, stretching of the eyelid skin is the cause of eyebrow raising. In middle-aged or older people with severe eyelid laxity, if the habit of raising the eyebrows is suppressed with botulinum toxin, the eyelid skin will cover the eye and interfere with daily life. In cases where the eyelid skin is highly elongated, submental rhytidectomy is indicated.

If a person has a droopy eyelid that causes poor eye opening and a tendency to raise the eyebrows, surgery for a droopy eyelid is indicated.

For those who have a large habit of raising their eyebrows without much involvement of the above factors, we ask for botulinum toxin injections (forehead) before bifurcation surgery.

Let's take a look at actual case photos.

This is the state of the patient at the time of initial examination. There is a tendency to raise the eyebrows quite strongly both with the eyelids open and closed. There is no excess skin on the eyelid and no droopy eyelid. Since double-lid surgery will not produce a beautiful double fold, the patient received botulinum toxin injections (forehead) prior to surgery.

This is two weeks after botulinum toxin injection (forehead). Compared to the initial examination, the habit of raising the eyebrows has improved. Surgery can be performed when the condition reaches this level.

In the photo taken immediately after the surgery, the eyebrow elevation is suppressed, so the skin on the brow side is covered over the bifurcation line. If this is the case, there is no problem.

At three months postoperatively, the effects of botulinum toxin on the forehead have begun to wear off, but after a period of downtime, botulinum toxin injections in the forehead are not mandatory.

We occasionally ask for botulinum toxin injections in the forehead for people who are considering double surgery, and we would appreciate your cooperation in this regard.

Assistant Director Daiki Kuroda

#: Dr. K's In-Depth Commentary Series

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