The toxin does not run down into the eye. With age the frontalis compensates for a weak levator — botox removes that compensation.
Hello. This is Dr. Lee Yumin of MeSOnBom Clinic.
One of the side effects patients raise most often is heaviness around the eyes after forehead treatment.
"Doctor, the toxin seems to have run down into my eye after the forehead treatment."
"My forehead feels as though a stone is sitting on it, and my eyelids droop so I look severe."
These are questions I hear once or twice a day in practice.
Is this heaviness and drooping really because the toxin flowed downward, as patients suspect?
To answer directly: no.
It is an entirely natural medical phenomenon arising from the anatomy of the facial muscles and the mechanics of ageing.
The misconception: that the toxin runs down into the eye after forehead treatment and makes the eye heavy. (Incorrect)
The truth: the toxin has not moved. With age, the forehead muscle had been borrowed to help open the eye, and botulinum toxin blocks that compensation. (Correct)
The answer: assess for ptosis before treatment, and adjust the injection points toward the upper forehead so that eyebrow movement is preserved.
Two main muscles interact anatomically when we open the eye. As ageing progresses, how much we rely on each one changes.
Levator palpebrae superioris: in youth, the muscle that opens the eye by the strength of the eyelid alone.
Frontalis: the muscle covering the forehead, used compensatorily to raise the eye as eyelid strength weakens with age.
The change in facial muscle mechanics before and after treatment is what patients most readily misunderstand.
The ally that had been helping the eye — the frontalis — is gone, so the eyelid feels as heavy as if a stone were resting on it.
As a doctor I would put it this way: the toxin has not physically flowed downward. Those who had been opening the eye by borrowing the strength of the forehead now have that compensatory mechanism blocked, leaving only their own weakened eyelid strength — a natural medical phenomenon.
Q1. If I am older or have ptosis, should I avoid forehead botulinum toxin?
A1. You can still have it. But you must tell your doctor beforehand if you have experienced heaviness in the past, or if you habitually open your eyes using your forehead.
Q2. How is the heaviness prevented?
A2. Medically, by adjusting the injection points and the dose.
Treating the upper forehead: rather than the lower forehead near the brows, the toxin is placed higher up, away from them.
The trade-off: this makes brow movement easier and markedly reduces heaviness, but the improvement in fine lines just above the brows is somewhat less.
Forehead botulinum toxin is not a simple one-dimensional treatment that erases wrinkles.
It is an anatomical treatment that adjusts the fine mechanics of the facial muscles.
Please check the following for a successful result.
Do you habitually raise your eyebrows when you look in the mirror?
Does the skin of your eyelid droop enough to feel it obstructs your view?
Are your forehead lines concentrated particularly just above the brows?
If any of these applies, discuss it fully with your doctor beforehand to find the best balance between improving wrinkles and opening the eyes comfortably. Thank you.
Our medical team will advise you based on your skin condition.
