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If the eyes are commonly referred to as the windows of the soul, then the eyebrow is the frame of humanity, emotion, personality, and empathy.  With prolonged habit plus genetics, the frowning negative expressions of the stress of life become present even at rest, but more obvious with animation, giving the angry – worried – upset – annoyed – stressed appearance that often has very little to do with the actual demeanor of the patient.  For over 25 years, neuromodulators have been used to obliterate glabellar lines in an attempt to soften the patient’s severe look.  In the early years of neuromodulators, most aesthetic injectors did not taken advantage of the anatomical studies of the glabellar complex and the variable contribution of these muscles to the position of the medial head of the brow – the aim was to eliminate the frown zones with no attention to what the eyebrows were doing or what they looked like after treatment.  The “Spock brow” became the new norm.  In the late 1990’s, injection specialists began elevating the eyebrows with neuromodulators to create what was called the “Botox® Brow Lift” by relaxing the eyebrow depressors so the static contribution of the frontalis muscle to eyebrow position was dominant.   Starting in 2003, the authors began “shaping” the eyebrows with precise injections of BoNT and then adding HA fillers to underpin and help shape the brows, incorporating cannulas in 2010 and by design – by choice – re-creating the peak of the feminine eyebrow pre-determined by the Golden Mean phi calipers.  

With ageing, exposure to both ultraviolet and infrared radiation, habitual smoking, and contact with pollution result in the facial skin deteriorating at a faster rate than the diminishing strength of the underlying mimetic muscles.  The repetitive movements of blinking, squinting and facial expressions further compound the facial envelope’s waning structure leading to both a static and dynamic discord of eyebrow position and movement.  As for other areas of the face, the artistic use of filler and neuromodulator can restore the proportion, harmony and balance of youth to the eyebrow region. Feminizing the eyebrow in the female patient is one of the more rewarding restoration projects, both for the syringe therapist and the patient. This is usually a serendipitous experience for patients as they are often unaware of the gradual negative changes in eyebrow position and shape. Even in those faces that have won the genetic DNA lottery, eyebrow shaping further enhances facial harmony, balance and proportion.  No longer the focus of isolated toxin therapy, non-surgical eyebrow shaping can best be accomplished by the synergy of neuromodulator and filler.

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