Moose Technique: A New Anatomical Perspective Treatment in Botulinum Toxin.

[INTRODUCTION] Botulinum toxin injections have transformed aesthetic treatments, improving patient confidence and emotional well-being. Eyebrow position plays a vital role in facial expression, yet botulinum toxin use in the forehead can cause issues like eyebrow ptosis or asymmetry. Recent research emphasizes the importance of a comprehensive pre-treatment assessment. The MOOSE technique, developed by the authors, incorporates new insights into muscle interactions to optimize botulinum toxin treatment for brow elevation while minimizing side effects like the omega sign.

[METHODS] This study involved 202 patients (89.1% female, mean age 40) treated with the MOOSE technique, focusing on upper third facial wrinkles. Primary outcomes included brow position, forehead line severity, treatment duration, and patient satisfaction. Aesthetic outcomes were assessed using the Merz Aesthetic Scales (MAS) at baseline and at two weeks post-treatment, corresponding to the peak efficacy of the toxin. Patient satisfaction was evaluated at both the two-week and four-month follow-up.

[RESULTS] The MOOSE technique resulted in a significant improvement in brow position, with an average gain of 2 points on the MAS. Patient satisfaction was remarkably high, with 100% of patients reporting a positive outcome at 15 days and 99% at four months. The average botulinum toxin dosage was 66 units per patient (range: 54-78 units). No cases of brow or eyelid ptosis were observed, and only one patient (0.49%) experienced transient edema. Interrater reliability of evaluations was excellent, with intraclass correlation coefficients ranging from 0.94 to 1.00 across all measured outcomes.

[CONCLUSION] The MOOSE technique provides an anatomically guided approach to botulinum toxin injections, enhancing aesthetic results while reducing complications. Its effectiveness underscores the value of individualized treatment based on muscle dynamics. Further research is needed to refine its application and assess long-term effects.