19/03/2026
When patients come in for upper lid blepharoplasty, sometimes one of the most important (and often overlooked) steps that happens before surgery is relaxing the forehead with Botox.
In this case, the first image shows a patient with significant upper eyelid skin excess, but also marked overactivity of the forehead muscle. You can see the deep dynamic lines formed over years of subconsciously lifting the brows to compensate for heavy upper lids.
This compensation can mask the true extent of the problem.
After carefully placed Botox, the forehead is relaxed, still with some natural movement, but the overactivity is reduced. This allows us to assess the eyelids more accurately and plan surgery based on the patient’s true anatomy, not their compensatory muscle habits.
In the second image, with the forehead no longer overdriving brow elevation, the full degree of skin laxity and heaviness of the muscle  becomes clear. This is crucial, as it guides how much tissue needs to be addressed during surgery, including any necessary muscle tightening.
The goal is always a natural, balanced, harmonious correction that restores function and aesthetics
Botox in this context isn’t just cosmetic — it’s a key part of surgical planning.