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Botox: Eyebrow Drooping Versus Eyebrow Arch Raising?

Can you advise what resolves faster: Botox injections that make the eyebrow raise into a high evil-like arch, or Botox injections that make the eyebrow droop to a sleepy-like eyelid? Or do they both resolve in about the same amount of time? My cousin loves Botox but has experienced both problems in the many years she’s used Botox and claims eyebrow/eyelid drooping heals just a little faster. Is this true?

Doctor Answers 9

Botox eyebrow drooping

The amount of time it takes for undesired effects to resolve depends on your anatomy, the number of units of Botox that was injected, how fresh the Botox was, the skill of the injector, and how quickly your body breaks down the Botox protein.  These variables are impossible to predict for you.  If these problems happen with a skilled and properly trained injector, they generally only last a few weeks before they resolve on their own, but sometimes, especially with arched brows, the effect can be improved with some additional "balancing" Botox (just a few units).  Make sure your injector is experienced and properly trained.


Maui Plastic Surgeon
4.0 out of 5 stars 22 reviews

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Botox

The toxin breaks down at the same rate regardless of where it is placed.  Your cousin might be more sensitive to return of movement in one area over another but they should be the same.

Robert Kearney, MD, FACS
La Jolla Plastic Surgeon
5.0 out of 5 stars 10 reviews

Botox and Brow Position

 Whether brow ptosis (dropped brow) or peaked brow laterally (Mr Spock look) lasts longer is impossible to say. Too many factors involved. However, proper technique should prevent brow ptosis and the Mr Spock look is very easily treated with just a drop of Botox over the elevated portion of the brow.

William M. Ramsdell, MD
Austin Dermatologic Surgeon
4.5 out of 5 stars 2 reviews

Eyebrow Drooping vs Eyebrow Arching with Botox

Full effects of Botox last 3-4 months. With that being said both eyebrow drooping and eyebrow arching will start to resolve much quicker than that depending on factors like: your body's metabolism, how drastic was it, number of units used in each area, etc. I'm not sure it matters truly which goes away first; good Botox technique doesn't have these side effects. Seek a qualified injector and you won't be battling either of these side effects!

F. Victor Rueckl, MD
Las Vegas Dermatologist
4.5 out of 5 stars 9 reviews

Your cousin needs to find a better BOTOX service.

Sometimes you get what you pay for.  I encourage you to look into my microdroplet botox, which is a patented botulinum toxin method for softening and lifting the eyebrows without the frozen forehead or recruitment lines.

Kenneth D. Steinsapir, MD
Los Angeles Oculoplastic Surgeon
5.0 out of 5 stars 19 reviews

Eye-BROW droop, Eye-LID droop, and High-arched Eyebrows after Botox...

Short answer: between high-arched eyebrows, an eyebrow droop, and a droopy ("sleepy") upper eyelid, the upper eyelid is likely the most unpredictable and may last the longest...

The following is a discussion of the 3 different complications you expressed concern about...

(1) A drooping eye-BROW may happen in the following scenarios:

-- When the brow-elevating muscle in the forehead, the Frontalis, receives too high a dose of Botox.
-- The Botox is sub-optimally placed too low in the forehead -- it should typically be placed at least 1 cm above the Brow.
-- Over-injection of the glabella area (between the brows).
-- It may also happen if you have a low set eyebrow to begin with, in which case any Botox to the Frontalis increases the likelihood of a brow droop.

Ironically, a droopy eye-BROW from Botox can sometimes be improved with MORE Botox -- this time, the Botox is typically injected into the outside (top of the crow's feet) part of the eye (aka the lateral aspect of the orbicularis oculi muscle) to generate a bit of a brow lift in that area -- by injecting more Botox and paralyzing the orbicularis muscle that normally acts to depress the brow in that area, you may get a slight compensatory brow lift...If the extra Botox does not improve the brow droop, it will likely last as long as the full duration of the Botox -- 3-4 months.

(2) High-arched eyebrows -- typically this happens when the outer part of your Frontalis (the brow-elevating muscle), is not adequately treated with Botox. This can be remedied with a Botox "touch-up" in that area to improve the symmetry. 

(3) A droopy UPPER eyelid may occur if the Botox is injected too close to your eyelid-elevating muscle, the levator palpebra superioris. In such a scenario, the Botox will diffuse inadvertently onto the levator muscle and cause an eyelid droop.  A lower Botox dose typically diffuses onto the levator muscle and so the good news is that the eyelid droop will typically NOT last as long as the full Botox duration of 3-4 months, and may in fact resolve in less than a month. Note however, if the eyelid droop occurs shortly after injection (i.e. within 3-4 days), then your eyelid levator muscle likely received a significant dose of Botox and your eyelid droop may not resolve for 1-2 months...

On a side note, you may have an increased risk of eye-LID drooping if you have a weakened upper eyelid muscle for neurological reasons, or a deeply set eye-BROW that would be more prone to drooping and result in skin gathering over the eyelid making the eyelid appear like it was drooping.

A droopy upper eye-LID due to Botox can be treated with Apraclonidine eye-drops which can provide a small (2mm) improvement -- Apraclonidine 0.5, 1-2 drops, 3 times per day. Make sure you put in one drop at a time, tilt your head back, and close your eyes to make sure none of the eye-drop leaks out. Be sure your prescribing physician discusses all the potential side-effects of the drops, such as "adrenaline-like" symptoms like anxiety or heart pounding; you may also experience eye irritation, eye dryness, and eye pain, amongst other symptoms. If these symptoms occur, you will likely need to take some lubricating eye drops, lower the dose, switch the eye-drops, or stop the drops altogether...

When it comes to Botox, I would recommend seeking the services of an experienced physician injector.

I think the key with Botox lies in truly understanding the anatomy of the injected area, and more importantly the variability in the anatomy between patients -- for brows, the forehead, and anywhere else you plan on receiving a Botox injection. This includes having a firm understanding of the origin, insertion, and action of each muscle that will be injected, the thickness of each muscle targeted, how deep beneath the skin the actual muscle resides, and the patient variability therein. As an aesthetic-trained plastic surgeon, I am intrinsically biased since I operate in the area for browlifts and facelifts, and have a unique perspective to the muscle anatomy since I commonly dissect under the skin, see the actual muscles themselves, and learn "first-hand" the incredible variability between patients -- live, "on the OR table" -- as opposed to via lectures or a cadaver dissection. For me, this helps guide where to inject and where not to. However, with that said, I know many non-aesthetic trained plastic surgeons and other physicians who know the anatomy well despite not operating in that area, and get good results.

Good luck.

Dr Markarian


Eyebrow drooping vs. eyebrow arch elevation from botox

I haven't studied which is faster to resolve, the outer eyebrow elevation unwanted side effect or the forehead/eyebrow droop after Botox. It is easier to correct the outer eyebrow arch elevation by placing one or two units in the unopposed frontalis forehead muscle which is elevating the eyebrow than it is to try to lift the eyebrow or forehead enough, with Botox, to make the patient feel more satisfied.

Ronald Shelton, MD
Manhattan Dermatologist
5.0 out of 5 stars 33 reviews

Botox for an arched eyebrow

It is difficult to predict which effect will wear off sooner.  I treat the forehead very conservatively to prevent the eybrows from drooping but if it did occur, it would only last a matter of weeks.  More units are injected into the frown which could cause the Spock brow so it could last longer, but it is so simple to adjust by placing a tiny amount of Botox above the area that the Spock brow shouldn't last any time at all.  Your cousin should be treated by a board certified dermatologist or plastic surgeon to try and prevent any disappointment.

Martie Gidon, MD, FRCPC
Toronto Dermatologist
5.0 out of 5 stars 18 reviews

Botox Effect on Eyebrow

Great injectors use Botox as a tool to shape the brow into a more aesthetic position.  This involves an intimate knowledge of the anatomy, muscle compensation patterns, muscle balance and diffusion properties of the product.  While everyone occasionally will get a brow droop or peaked brow, consistently getting this result is the sign of a poor injector.  The best way to treat a brow problem is to not get it in the first place.

Take a look at the following article.  Core aesthetic providers have a nearly 30% higher patient satisfaction rate for Botox.  

Joseph Campanelli, MD
Minneapolis Facial Plastic Surgeon
4.5 out of 5 stars 8 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.