Kenneth Steinsapir, M.D., says industry statistics back his theory that lots of people don’t get botulinum toxin injections because they don’t want to look frozen.
“Allergan has done market research on Botox, where they query the public on who is and who is not getting the service. And [the company] tells us that only 5% of the potential market gets cosmetic botulinum toxin,” says Dr. Steinsapir, an oculofacial surgeon who practices in Beverly Hills, Calif. “I’m sure you have a segment of the market that will probably never do it for whatever reason, but I think a lot of women don’t like the frozen face. And I don’t think doctors are always sensitive to that.”
While some highly experienced and talented injectors can avoid the frozen look, the average physician injector doesn’t have a template from which to get consistently natural-looking results, according to Dr. Steinsapir. So, he developed and patented the Microdroplet Lift to create a botulinum toxin “brow lift” that can be easily mastered and is reproducible without freezing the forehead, he says.
How The Microdroplet Lift Works
The Microdroplet Lift concentrates treatment in the brow depressors along the eyebrow and glabella, using a pattern of small volume injections delivered just below the skin where the muscles of facial expression insert into the skin. Treatment in the forehead is not needed to preserve natural forehead movement, he says.
“What’s interesting about standard treatment is nobody really thought about the volume of the injection. Nobody describes where that injection should go and the tissue depth,” Dr. Steinsapir says. “If you think about the 11-line area, the tissue there is about 7 mm thick, and there are a lot of different layers that come together. Obviously, what depth you inject and what volume you use to place product will make a difference in the outcome.”
In standard treatment, doctors inject as much as .1 mL and will do five to seven of those larger volume injections in the 11-line area. The standard off-label treatment includes the crows’ feet, the 11s and some type of forehead pattern of injection, he says.
“A lot of what we don’t like about the service is the result of unwanted diffusion of the product that the doctor and patient may not fully understand, but they clearly don’t like the result, which is that sort-of Desperate Housewives’ glass-smooth forehead that can’t move,” Dr. Steinsapir says.
To avoid that, the Microdroplet Lift calls for administering 10 to 30 microliter (0.01 to 0.03 mL) injections in a pattern across the eyebrow and glabellar areas. Typically, doctors place 60 to 100 microinjections just below the skin, according to Dr. Steinsapir.
“This effectively traps and concentrates the medication, so it can’t diffuse and cause ptosis and only weakens the brow depressor muscles,” he says. “The overall dose of Xeomin [Merz Aesthetics] or Botox [Allergan] for the Microdroplet Lift is 30 to 50 units, with most patients doing well with the lower dose. The dose of Dysport [Galderma] is of course higher.”
Dr. Steinsapir offers these dynamic before and after videos on YouTube to show animated patient results:
The longevity of results from the Microdroplet Lift is similar to other cosmetic botulinum toxin treatments. Complications from the Microdroplet Lift are considerably lower than with the standard approach to botulinum toxin treatment of the crows’ feet and 11s.
Dr. Steinsapir, who has treated more than a thousand patients using the Microdroplet Lift approach and reported on outcomes of 563 consecutive microdroplet treatments on 227 patients in this paper published July-August 2015 in Ophthalmic Plastic and Reconstructive Surgery, says one case of transient ptosis was seen, representing .2%.
“Other treatment series have reported rates of ptosis as high as 4%,” he says.
The Neuroscience of Facial Expression
To get consistent results with the Microdroplet Lift, Dr. Steinsapir advises injectors carefully study the training video he has developed or participate in a live treatment course.
“The Microdroplet Lift paradigm is based on the neuroscience of facial expression. A lot of what we don’t like at the brow is the resting brow pinch, which makes us look mean. By concentrating treatment in the brow depressor muscles, the brow pinch relaxes, and we look younger, more relaxed and friendlier. By weakening the brow depressors, the frontalis muscle, the principle brow lifter, does not have to work as hard, so forehead lines diminish without freezing natural forehead movement.”
Dr. Steinsapir is launching a website to provide consumers information about this service and a directory of Microdroplet Lift injectors at www.microdropletlift.com. The site will feature a dedicated subscription service for injection professionals. The subscription includes training materials, a limited license to perform the service, access to marketing materials and a listing in the injector directory.
The initiation fee is $300, which includes the first month’s subscription. Afterwards, the monthly subscription is $75 per month. The site is expected to go live mid May 2017, according to Dr. Steinsapir.
“There are some injectors that will need a live course. But sophisticated injectors can view the video and safely and reliably perform the service. We are asking them to treat a couple of their office staff and submit before and after pictures to confirm their proficiency, before activating their directory listing.” Dr. Steinsapir.
These images will also be used on the website to help promote the injectors, he says.