When treating patients with hooded eyelids, injectors frequently struggle with administering botulinum toxin. The reason for this is the risk of causing ptosis, also known as upper eyelid drooping.
Hooded eyelids are caused by skin folding downwards from the brow bone over the crease, either at birth or through the process of aging. Whilst there are grades of how hooded the lid is, additional drooping of the hooded eyelid is generally undesirable and may impair vision.
This is a complicated subject that can raise concerns even among fully qualified aesthetics practitioners early on. However, with a thorough understanding of the theory and plenty of practice, dealing with hooded eyelids should become second nature in no time.
It is critical to understand proper botulinum toxin placement based on the individual’s facial anatomy. Everyone has different muscle strength and sensitivity, in addition to unique facial features.
All of this must be considered when injecting botulinum toxin so that it is injected into the correct area and depth. Failure to do so can result in ptosis and damage to the muscles that control the movement of the brows and/or eyelids. This can lead to ptosis of the eyelid or brow. However, if treatment is not lateral enough in the frontalis muscle, it can cause the brows to rise, giving patients a startled appearance.
*Please note that if a patient already has extremely hooded eyelids prior to treatment, the risk of ptosis is usually a sign that they are not a good candidate for frontalis muscle botulinum toxin injections.
To perfect your technique as an injector, you need to pay attention to many factors. This includes anatomy, facial structure, and product placement. Equally important is understanding when not to treat someone and how to talk to patients about potential complications.
Take your time exploring the glabellar corridor area, especially if the patient has highly hooded eyelids or a lined glabellar area. When dealing with such issues, it is preferable to use small doses of toxins, emphasizing how these must be placed correctly.
How to raise brows or eyelids with Botox:
For patients who wish to have their brows or lids raised slightly, being able to define the precise botox injection site(s) to achieve this is an advanced skill. It essentially involves treating the brow depressors to create lift, primarily the glabellar complex and the superior fibers of the orbicularis oculi muscles.
Eyebrows can appear widened depending on the muscle sensitivity in this area. This can be used to help raise brows but there is also the potential for eyebrow droop if it is not administered correctly. Some people may have poor muscle function in the muscle that controls the eyelids, so it is important to check for this each time.
The key thing here is if someone has very hooded eyelids they are not suitable for treating the frontalis muscles. It is best to treat the glabellar complex. Do not treat the frontalis muscle alone as it can knock out the only levator muscle in the brow leading to a potential drop in brow position.
It is worth noting that what would generally be considered an eyelid lift cannot be achieved with botulinum toxin alone. This usually requires upper eyelid surgery or blepharoplasty procedures.