alluring manner to signal openness and mystery to a potential suitor. Male brows are optimally low and flat. For purposes of this discussion, it is sufficient advice to recommend avoiding injection into the frown complex in such a manner as to arch or “Spock†the male brow and to be very conservative when injecting the frontalis muscle to avoid a mannequin appearance that can be feminizing.
To raise the dropped medial brow, I usually inject a generous amount into the procerus (about 10 units) and 2-5 units to each brow tail where the lateral-superior orbicularis oculi depresses the lateral brow. At the same time, I also inject 2-5 units into the lateral frontalis to trigger compensatory strengthening of the medial frontalis and lift those scowling medial brows. Avoid injecting too close to the brow when injecting into the lateral frontalis as you do not want to drop the lateral brow. I might add I do a similar pattern in my patients with widely splayed medial brows. This “cow look†as I call it, can be natural anatomy from a wide nasal root, but is
more often iatrogenically induced from too much toxin into the corrugators in a poor subject with an unobservant provider injecting by the cookie cutter pattern in the package insert.
To correct the concerned and distressed look of a low lateral brow, I usually do the following: 2-5 units into the lateral brow tail and 6-10 units into the central and superior fibers of the frontalis muscle (Figures 3 and 4). This results in compensatory strengthening of the lateral frontalis on each side to lift the lateral brows. It is important to understand that one must evaluate each patient as there is no cookbook to brow shaping. Sometimes nothing is better than a hyaluronic acid filler injected into the lateral eyebrow to give the best arch.
In addition to brow lift and shaping, use of neuromodulators can correct baseline brow asymmetry (Figures 5 and 6). Close examination often reveals that brow asymmetry is from lax skin or mild ptosis on one side and the resulting compensation of the
