Botulinum Toxin for Eyebrow Shaping: A

Systematic Review
Samer Jabbour, MD,* Cyril Awaida, MD,* Elio Kechichian, MD,† Youssef Rayess, MD,*
Youssef Abdelmassih, MD,‡ Warren Noel, MD,x Lena el Hachem, MD,k
and Marwan Nasr, MD*

BACKGROUND Currently, there is no standardized approach for eyebrow shaping with botulinum toxin, and
controversies still exist regarding this subject.

OBJECTIVE The objective of this systematic review is to summarize and compare all the published data
regarding eyebrow shaping with botulinum toxin.

METHODS On March 10, 2017, an online search of published articles in the Medline, Embase, and Cochrane
databases were conducted. All articles that used objective measurements to quantify the eyebrow changes
after botulinum toxin injection were included in this review.

RESULTS Eleven studies were selected for inclusion with a total of 585 patients. All the included studies used
onabotulinumtoxin A. Seven studies injected both the lateral and the medial eyebrow depressors, 2 studies
injected the lateral depressors alone, and 2 studies injected the medial depressors alone. The highest elevation
was observed in the lateral brow (0.4–4.8 mm). Bruising and headache were the most frequently reported
complications, and only 5 cases of eyelid ptosis were noted.

CONCLUSION Botulinum toxin injection for eyebrow shaping is a noninvasive, safe, and reproducible
procedure. Eyebrow reshaping can be achieved by targeting different muscle groups. However, further
randomized controlled trials are warranted.

The authors have indicated no significant interest with commercial supporters.

E yebrows play an important role in facial

expression and beauty.1 A widely recognized
eyebrow model was described by Westmore in 1974.2,3
He stated that both medial and lateral edges of the
eyebrow should fall on the same horizontal level and
the eyebrow arch peak should be on a vertical line
tangential to the lateral limbus.2,3 The eyebrows are
subject to changes with age as the lateral contour and
apex of the youthful brow flatten over time.4
Correcting these age-related eyebrow changes gives
a youthful, attractive appearance.5–7 This was
traditionally done using invasive procedures, such as
transpalpebral brow lift,8 endoscopic brow lift,9
frontal hairline brow lift,10 temporal brow lift,11 coronal
brow lift,12 direct brow lift,13 and the use of threads.14
All of these procedures are complex, irreversible and
invasive, and do not always reproduce a naturally
shaped eyebrow.3,4 Nowadays, patients are
seeking minimally invasive procedures for facial
rejuvenation.15 In this context, the use of the botulinum
toxin for nonsurgical brow lifting has increased in
popularity.11,16–20 The brow is a dynamic structure
affected by the interaction of antagonist muscles. These
muscles are divided into medial and lateral eyebrow
depressors and eyebrow elevators. The procerus,
corrugator, depressor supercilii, and medial orbicularis

Departments of *Plastic and Reconstructive Surgery, †Dermatology, and ‡Ophthalmology, Faculty of Medicine,
Saint-Joseph University, Hotel Dieu de France Hospital, Beirut, Lebanon; xDepartment of Plastic and Reconstructive
Surgery, Saint-Joseph Hospital, Paris, France; kDepartment of Obstetrics and Gynecology, Lebanese American University
Medical Center, Beirut, Lebanon

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· ·
ISSN: 1076-0512 Dermatol Surg 2017;43:S252–S261 DOI: 10.1097/DSS.0000000000001410

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Figure 1. Eyebrow depressor and elevator muscles.
Medial brow depressors: procerus (1), corrugator (2),
depressor supercilii (3), and medial orbicularis fibers (4).
Lateral brow depressors: lateral fibers of the orbicularis (5).
Brow elevators: frontalis (6).
fibers are the medial eyebrow depressors. The lateral
fibers of the orbicularis are the lateral depressors.15,21
The frontalis muscle is the main elevator of the
eyebrows16 (Figure 1). Chemodenervation of the
depressor muscles allows the unopposed frontalis
muscle to lift the eyebrows.22 These muscles have been
previously targeted using different botulinum toxin
injection techniques, concentrations, and
doses.16,17,20,23,24 Currently, there is no standardized
Figure 2. Stepwise approach to select the final 11 articles included in the systematic review. All the included articles used
objective measurements to quantify the eyebrow changes.
© 2017 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.
JABBOUR ET AL
approach for eyebrow shaping with botulinum toxin,
and controversies still exist regarding this subject. The
objective of this systematic review is to summarize all the
published data regarding eyebrow shaping with
botulinum toxin by comparing injection techniques,
injection sites, toxins, dosages, adverse events, eyebrow
measurement methods, and the objective eyebrow
changes.
Methods
On March 10, 2017, the first 2 authors (S.J. and C.A.) of
this study conducted a search of the Medline, Embase
and Cochrane databases. The initial search was per-
formed using specific eyebrow and botulinum toxin
terms: (browlift OR brow OR eyebrow OR periorbital
OR periocular) AND (elevation OR height OR shape
OR shaping OR lift OR lifting OR rejuvenation) AND
(botox OR abobotulinum OR onabotulinum OR inco-
botulinum OR botulinum OR toxin). All English and
French articles published before the search date were
evaluated for inclusion in this review. Studies related to
eyebrow modification with botulinum toxin were
selected based on their titles and abstracts and were
obtained and read in full. The bibliographies of each
43:12S:DECEMBER SPECIAL ISSUE 2017 S253
 BOTULINUM TOXIN FOR EYEBROW SHAPING

article were manually screened for additional studies. All
articles using objective measurements to quantify the
eyebrow changes were included in this review. Excluded
studies were those lacking a detailed description of the
procedure. The first 2 authors (S.J. and C.A.) unani-
mously agreed on the final selection of the included trials.
Results
The initial search of the databases yielded 314
results, of which 139 were duplicates. Of the 175
unique studies, 72 were retained based on the titles
and abstracts. Four additional articles were
retrieved by the manual search of the bibliographies.
Based on the inclusion and exclusion criteria, 11
articles were included in the current review. The
stepwise approach for study selection is summarized
in Figure 2.
All the included studies were published between 1998
and 2015. The total number of included patients was
585. The mean age of patients was 45 years ranging
from 28 to 62 years. The female to male ratio was 9 to
1 (Table 1).
Injection Techniques and Products
All the studies used onabotulinumtoxinA (ONA)
reconstituted with normal saline. The authors did not
find any published data that used other botulinum
toxin types. The most commonly used product con-
centration was 5 U/0.1 mL.17,20,23–25 In the included
studies, the lateral17,23 or the medial24,30 eyebrow
depressors were injected alone or in combina-
tion16,20,25–29 (Table 2). Figure 3 illustrates injection
techniques included in this review.
Eyebrow Measurement Methods
Objective measurements of eyebrow heights were
done either clinically using a caliper17,23,27–29 or digi-
tally24–26,30 using preinjection and postinjection pho-
tographs. Eyebrow changes were measured 2 weeks

TABLE 1. Characteristics of Included Studies

Total Units of
Study Botulinum Toxin No. Female Mean Age Follow-
Study Country Design Per Patient Patients (%) in y (Range) Up
Ahn and colleagues17 USA P 14–20 22 17 (77) NR 6 mo
Carruthers and Canada R 10 20 20 (100) 49.3 2–20 wks
Carruthers24
20 19 19 (100) 49.9
30 20 20 (100) 46.2
40 20 20 (100) 45.3
Frankel and Kamer30 USA R 20 29 25 (86) 32–62 2 wks
Huang and USA NR 30 11 11 (100) 30–60 7–10 d
colleagues25
Huilgol and Canada NR 10–14 7 7 (100) 37 (31–42) 1 mo
colleagues16
Kokoska and USA P 15–51 14 27 (93) NR 2 wks
colleagues20
Lee and colleagues27 Korea NR 28 27 27 (100) 32–61 2 wks
44 21 21 (100)
Sneath and Canada P 64 23 23 (100) 28–53 4 wks
colleagues28
Steinsapir and USA R 33 227 175 (77) 46 10–45 d
colleagues26
Tiryaki and Ciloglu29 Turkey NR 30–45 115 106 (92) 42 2 wks
Uygur and Turkey NR 12 10 10 (100) 40 (28–53) 14 d
colleagues23

NR, not reported; P, prospective; R, retrospective.

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 JABBOUR ET AL

TABLE 2. Summary of Botulinum Toxin Injection Techniques

Injection Site (No. Injection

Product Used Points Used), [Total Units Adverse Events
Study and Preparation Injected Per Site] (No. Patients)
Medial eyebrow
depressors injection
alone
Carruthers and Botox* (ONA) Glabella: (7), [10–40] Headache (9)
Carruthers24 reconstituted to 2.5–10
U/0.1 mL
Migraine (1)
Tension on forehead (1)
Eyebrow ptosis (2)
Pain upper nose (1)
Frankel and Kamer30 Botox* (ONA) Glabella (NR), [20] NR
Lateral eyebrow
depressors injection
alone
Ahn and colleagues17 Botox* (ONA) Superolateral orbicularis oculi Bruising (5)
reconstituted to 5 U/0.1 (3), [7–10]
mL
Eyelid ptosis (2)
Excess elevation (1)
Uygur and colleagues23 Botox* (ONA) Superolateral orbicularis oculi NR
reconstituted to 5 U/0.1 (3), [6]
mL
Lateral and medial
eyebrow depressors
injection
Huang and ONA reconstituted to 5 U/ Glabella (1), [5] None
colleagues25 0.1 mL
Superolateral orbicularis oculi
(4), [10]
Huilgol and colleagues16 Botox* (ONA) Glabella (1), [7–10] None
reconstituted to 10 U/
0.1 mL
Superolateral orbicularis oculi
(1), [2.5]
Kokoska and Botox* (ONA) Glabella (3), [15] NR
colleagues20 reconstituted to 5 U/0.1
mL
Forehead (5), [20]
Crow’s-feet (2), [8]
Lee and colleagues27 Botox* (ONA) Glabella (1), [10] Bruising (1)
reconstituted to 10 U/
0.1 mL
Superolateral orbicularis oculi
(2), [5]
Crow’s-feet (2), [4}
Glabella (1), [18]
Forehead (2), [8]
Superolateral orbicularis oculi
(2), [5]
Crow’s-feet (2), [4]

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 BOTULINUM TOXIN FOR EYEBROW SHAPING

TABLE 2. (Continued )

Injection Site (No. Injection

Product Used Points Used), [Total Units Adverse Events
Study and Preparation Injected Per Site] (No. Patients)
Sneath and Botox* (ONA) Glabella (5), [12–27] NR
colleagues28 reconstituted to 10 U/
0.1 mL
Forehead (5), [8–31]
Crow’s-feet (3), [5–30]
Steinsapir and Botox* (ONA) Glabella, superolateral Eyelid ptosis (1)
colleagues26 reconstituted to 3.3 U/ orbicularis oculi, and Crow’s-
0.1 mL feet (microdroplets) [33 in
total]
Tiryaki and Ciloglu29 Botox* (ONA) Glabella (NR), [NR] Bruising (12)
reconstituted to 4 U/0.1
mL
Forehead (NR), [NR]
Crow’s-feet (NR), [NR]

*Botox (Allergan, Inc., Irvine, CA).

NR, not reported; ONA, onabotulinumtoxinA.

after the injection in most of the studies. The both the middle and medial brow, respectively
medial,20,23–28,30 middle,16,17,20,23–28,30 and (Table 3).
lateral17,20,23–29 eyebrow heights were calculated by
measuring the distances from reference anatomical Adverse Events
structures or planes (medial canthus,20,23,27,30 lateral
Adverse events were present solely in the first weeks
canthus,17,20,23,27,29 eyelid margin,20,23 pupil,16,17,20,25–27,30
following the treatment. Bruising and headache were
and caruncles24,28) to either the inferior16,17,23,24,27–30 or
the most frequently reported complications, and only
the superior20,25,26 border of the eyebrow (Table 3).
5 cases of eyelid ptosis were noted (Table 2).

Objective Eyebrow Changes Discussion

The highest elevation was observed at the lateral
part of the eyebrow reaching 4.8 mm. Only 1 study
reported no changes in the lateral eyebrow height
after the injection28 and another noted an initial
depression of the lateral eyebrow (20.76 mm) fol-
lowed by an elevation at 12 weeks of follow-up
(0.64 mm).24 This was observed in a subgroup of
patients who were injected with 10 U of ONA into
the glabella.24 The middle and medial eyebrow
heights increased with a maximal elevation of
2.1 mm and 0.91 mm, respectively. Only Kokoska
and colleagues20 reported no changes in the middle
and medial eyebrow heights. Sneath and col-
leagues28 noted a depression of 1.07 and 1.06 mm of
In this review, it was found that botulinum toxin
injection in most of the included studies produced the
highest elevation in the lateral brow (0.4–4.8 mm)
followed by the middle brow (0.4–2.1 mm) and the
medial brow (0.2–0.91 mm). This predominant lateral
elevation may be responsible for the youthful and
natural appearance obtained with botulinum toxin
eyebrow shaping. In fact, Matros and colleagues4
demonstrated that with age, the brow does not
descend but flattens in its middle and lateral portions.
They stated that most surgical techniques that “ele-
vate” the brow instead of “reshaping” it produce an
unnatural appearance. They concluded that the tech-
niques that selectively elevate the lateral brow are

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 JABBOUR ET AL

Figure 3. Injection points used in the included studies. (A) Ahn and colleagues17: A total of 7 to 10 U were injected into the
superolateral portion of the orbicularis oculi muscle using 3 injection points, below the lateral brow on each side. Uygur and
colleagues23: A total of 6 U were injected into the superolateral portion of the orbicularis oculi muscle using 3 injection points, below
the lateral brow on each side. (B) Carruthers and Carruthers24: 10, 20, 30, or 40 U were injected into the glabella of each patient using
7 injection sites: The total dose was divided among 7 injection points: 20% of the total dose was injected into the procerus muscle,
15% into each of the 2 corrugator muscles, and 50% into 4 sites in the orbicularis oculi (15% at each of the 2 sites above the medial
canthus and 10% at each of the 2 sites above the midpupillary line). (C) Huang and colleagues25: 5 U were injected into the glabella at
each medial brow using a single injection point. Ten units of ONA was injected along the lateral orbital rim using 4 equally spaced
injections. (D) Huilguol and colleagues16: 7 to 10 U were injected into the glabella immediately below a line joining the eyebrows
using a single injection point. Then, 2.5 U of ONA was injected into the superolateral eyebrow above the eyebrow at the level of the
lateral canthus. (E) Lee and colleagues27: 5 U was injected into the superolateral orbicularis using 2 injection points. Two units was
injected 1.5 cm lateral to the lateral canthus. Two units was injected inferior to the lateral canthus injection point. Ten U was injected
into the glabella using a single injection; 4 U was injected into the corrugator at each medial brow, 4 U was injected into the frontalis
2 cm above the corrugator injection point. (F) Steinsapir and colleagues26: A total of 33 U were injected in microdroplets of 10 to 20
mL into the brow, glabella, and crowfeet areas. Sixty to 100 microdroplets were used per patient. ONA, onabotulinumtoxinA.

more likely to have a rejuvenating effect on the female
face.4
In 2 studies, only the lateral brow depressors were injec-
ted using similar injection techniques.17,23 Both showed
an elevation of the central and lateral brow. The highest
eyebrow elevation in the present systematic review was
achieved by Ahn and colleagues17 who injected the
superolateral portion of the orbicularis oculi alone (4.8
mm). Previous reports concluded that paralyzing the
brow depressors results in an elevation of the brow due to
the unopposed action of the brow elevators.22
Carruthers and Carruthers24 only injected the medial
brow depressors. They found that the injection of 20 to
40 U of ONA into the glabella leads to an early ele-
vation of the lateral brow 2 weeks after the injection
followed by a late central and medial elevation that
peaked at 12 weeks of follow-up. This can be
explained by the fact that the injection of the medial
brow depressor muscles results in a diffusion of the
toxin into the frontalis muscle, paralyzing its medial
fibers. This partial paralysis generates an increased
resting tone of the remaining frontalis fibers and an
early elevation of the lateral eyebrow. Thus, when
glabellar injections are requested for rhytides treat-
ment, the patients should be warned about resultant
lateral eyebrow elevation.
Most of the included studies injected both the medial
and the lateral depressor muscle groups without
injecting the frontalis muscle to create an objective
brow elevation.16,20,25,26,28,29
One study reported no change20 in the eyebrow posi-
tion and another reported a depression28 of the brows

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 BOTULINUM TOXIN FOR EYEBROW SHAPING

TABLE 3. Summary of Measurement Methods

Evaluation Reference for Positions Objective Eyebrow

Study Method Used Measurements Measured Elevation, mm
Ahn and Caliper Pupil and lateral 2 (middle and Middle: 1
colleagues17 canthus lateral eyebrow)
Lateral: 4.8
Carruthers and Photographs Horizontal plane 3 (medial, middle, Medial: 0.2–0.83
Carruthers24 passing through the and lateral
caruncles eyebrow)
Middle: 0.4–1.05
Lateral: 0.4–1.08
Frankel and Photographs Pupil and medial 2 (medial and Medial: higher in 32% of patients,
Kamer30 canthus middle eyebrow) unchanged in 60% of patients,
and lower in 8% of patients
Middle: higher in 48% of patients,
unchanged in 40% of patients,
and lower in 12% of patients
Huang and Photographs Pupil 3 (medial, middle, Medial: 0.91
colleagues25 and lateral
eyebrow)
Middle: 1.98
Lateral: 0.68
Huilgol and NR Pupil 1 (middle eyebrow) Middle: 1
colleagues16
Kokoska and NR Pupil, medial, and 3 (medial, middle, Medial: no change
colleagues20 lateral canthus and lateral
eyebrow)
Middle: no change
Lateral: no change
Patients also injected in the
forehead had a medial eyebrow
depression
Lee and Caliper Pupil, medial, and 3 (medial, middle, Medial: 0.9–0.92
colleagues27 lateral canthus and lateral
eyebrow)
Middle: 1.46–1.48
Lateral: 1.3–1.37
Sneath and Caliper Horizontal plane 3 (medial, middle, Medial: 21.06
colleagues28 passing through the and lateral
caruncles eyebrow)
Middle: 21.07
Lateral: no change
Steinsapir and Photographs Pupil 3 (medial, middle, Average eyebrow elevation: 0.4
colleagues26 and lateral
eyebrow)
Tiryaki and Caliper Lateral canthus 1 (lateral eyebrow) Lateral: 3.33
Ciloglu29
Uygur and Caliper Upper lid margin, 3 (medial, middle, Middle: 2.1
colleagues23 medial, and lateral and lateral
canthus eyebrow)
Lateral: 1.35

after botulinum toxin injection. In both studies, the tion of the eyebrow elevators eliminates the potential
forehead was injected along with the eyebrow elevation that the brow depressors paralysis is expec-
depressors. This indicates that the concomitant injec- ted to provide. Kokoska and colleagues20 suggested

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Figure 4. Preinjection anteroposterior photograph of a 46-
year-old patient (above), 2 weeks after the injection of 20 U of
ONA into the lateral brow depressors (below). Here, ONA was
injected superficially into the lateral orbicularis oculi muscle
below the eyebrows using 5 equally spaced injections from
the lateral limbus to the lateral canthus. Each point was
injected by 2 U of ONA. ONA, onabotulinumtoxinA.
that when treating the forehead for rhytides, care
should be taken to avoid lowering the eyebrows. In
fact, some patients constantly and actively raise their
eyebrows, and paralyzing the frontalis muscles in these
patients will result in a brow ptosis after botulinum
toxin injection. Assessment of the frontal muscle
activity and resting tone should be done prior to con-
comitant injection of the forehead.
Botulinum toxin injection reshapes the eyebrows in 3
different ways: (1) when the lateral depressor muscles
are injected, selective paralysis of the depressors
results in an unopposed elevation of the brow by the
frontalis muscle; (2) when the medial depressor
muscles are injected, the diffusion of the toxin into the
medial frontalis fibers causes a partial paralysis of the
medial frontalis and an increase in tone in the lateral
frontalis fibers, resulting in an elevation of the brow;
(3) when the frontalis muscle is injected along with
the eyebrow depressors, the potential eyebrow ele-
vation by the frontalis is attenuated sometimes
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JABBOUR ET AL
Figure 5. Preinjection anteroposterior photograph of a 44-
year-old patient (above). Photograph of the patient 2 weeks
after the injection of 28 U of ONA into the medial and lateral
brow depressors (below). In this case, ONA was injected
superficially into the lateral orbicularis oculi muscle below
the eyebrow using 5 equally spaced injections from the
lateral limbus to the lateral canthus. Two additional intra-
muscular injections were done into the medial eyebrow
depressors: the first injection was done at the medial edge
of the brow, and the second injection was done 1 cm lateral
to the first injection just above the eyebrow. Each point was
injected by 2 U of ONA. ONA, onabotulinumtoxinA.
resulting in a paradoxical depression of the
eyebrows.
In this systematic review, it is found that injecting
either the lateral or the medial depressors alone or in
combination resulted in an elevation of the eyebrow.
Thus, in practice, to obtain the requested eyebrow
elevation, the authors inject either the lateral
depressors alone or both the lateral and medial
depressors after discussing the different procedures
with the patient. Usually, 3 clinical scenarios are
encountered:
(1) When the patient requests an eyebrow elevation
procedure alone without glabellar rhytides injec-
tions, the authors inject the superolateral orbi-
cularis oculi muscle along the lateral orbital rim
using 5 equally spaced injection points from the
43:12S:DECEMBER SPECIAL ISSUE 2017 S259
 BOTULINUM TOXIN FOR EYEBROW SHAPING
lateral limbus to the inferior orbital rim (2 units
of ONA per injection point) (Figure 4).
(2) When the patient requests eyebrow elevation and
is not opposed to glabellar injection, the authors
inject the same 5 lateral points with 2 additional
intramuscular injections into the medial eyebrow
depressors. The first injection is done at the
medial edge of the brow, and the second is done
1 cm lateral to the first one just above the
eyebrow (2 units per injection point) (Figure 5).
These injections are not meant to treat the
glabellar rhytides but to weaken the depressors
just enough to allow eyebrow elevation. When
the treatment is done for the sole purpose of
eyebrow elevation, the authors do not over inject
the glabellar region to maintain a natural move-
ment of the eyebrows. The procerus muscle is
also weakened by the diffusion of the toxin.
(3) When glabellar rhytides treatment and eyebrow
elevation are both requested by the patient the
glabella is injected using 5 points (4–8 units per
injection point) in addition to the 5 lateral
injection points.
In general, when eyebrow elevation is requested, the
authors avoid injecting the frontalis muscle. If fore-
head injections are required for rhytides treatment, the
lowering effect that these injections might have on the
eyebrows should be explained to the patient prior to
injection.
Eyebrow shaping with botulinum toxin can be con-
sidered a safe procedure because all the reported
adverse events were mild and transient. Eyelid ptosis
occurred in less than 1% of the included patients.
Table 4 summarizes the main findings attained in this
review.
There are some limitations to this systematic review.
Only 3 of the included trials were prospective. The
absence of a randomized controlled trial prohibited
the authors from conducting a meta-analysis to com-
pare the different botulinum toxin injection techni-
ques. Thus, this systematic review was limited to
a form of pooled analysis. The high variability of the
included studies, especially in the objective measure-
ment methods restricted the interstudy comparison.
S260 DERMATOLOGIC SURGERY
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TABLE 4. Key Points
The most commonly used product concentration was 5
U/0.1 mL.
Lateral and medial eyebrow depressor muscles can be
injected alone or in combination.
Botulinum toxin injection in most of the included
studies produced the highest elevation in the lateral
brow followed by the middle brow and the medial
brow.
Adverse events are transient. Bruising and headache
are the most frequently reported complications.
Eyelid ptosis occurs in less than 1% of patients.
Objective measurements of eyebrow heights can be
done either clinically using a caliper or digitally using
preinjection and postinjection photographs.
Botulinum toxin injection reshapes the eyebrows in 3
different ways:
1. The selective paralysis of the depressors permits
an unopposed elevation of the brow by the frontalis
muscle.
2. The partial inactivation of the medial frontalis
fibers increases the tone of the lateral frontalis
fibers, resulting in an elevation of the brow.
3. The injection of the frontalis muscle along with the
eyebrow depressors can result in a paradoxical
depression of the eyebrows.
Another bias was the publication bias because only
published trials were included.
Conclusion
Botulinum toxin injection for eyebrow shaping is
a noninvasive, safe, and reproducible procedure.
Eyebrow reshaping can be achieved by targeting dif-
ferent muscle groups. The objective elevation of the
brow with botulinum toxin has been well docu-
mented. However, future, adequately designed, ran-
domized, controlled trials are needed to compare the
different injection techniques and assess their impact
on brow shape and position.
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Address correspondence and reprint requests to: Samer
Jabbour, MD, Faculty of Medicine, Saint-Joseph
University, Hotel Dieu de France Hospital, Alfred
Naccash Boulevard, Beirut, Lebanon, or e-mail:
samermed@gmail.com
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