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Drooping After Botox?

Yesterday I had 10 units of botox done on my forehead lines only, by an experienced dermatologist. This was my first time trying botox. Today I noticed that one of my eyebrows is slightly lower than the other. It's hardly noticeable but I'm worried that it's going to get worse over the next week. Is 10 units enough to cause droopiness? If I am noticing a slight droop today, does that mean it will only get worse over the next few days? When can I expect this to correct itself?

Doctor Answers 18

Will my Brow droop get worse?

Short answer -- I would first wait 7-10 days to see the full effects of the Botox and return to your injecting physician for reassessment.

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

(1) When the brow-elevating muscle in the forehead, the Frontalis, receives too high a dose of Botox.

(2) The Botox is sub-optimally placed too low in the forehead -- it should typically be placed at least 1 cm above the Brow.

(3) Over-injection of the glabella area (between the brows).

(4) 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.

Please seek 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

Can Botox Make One Eyebrow Higher or Lower?

Hi Anon.  It's very possible that your asymmetry, if it has come on after treatment, will fix itself over the next week and if it does not, could probably be remedied fairly easily after another visit.

As Dr. Prendeville pointed out, we often have patients present this same issue at their 2 week follow up and when we look at the before pictures they realize that a small imperfection that they think is new was actually pre-existing.  In any event, make sure to get back to you injector to review the issue.  Good luck.

Harold J. Kaplan, MD
Los Angeles Facial Plastic Surgeon
5.0 out of 5 stars 6 reviews

Early assymetry after Botox.

It is not at all unusual to have early asymmetries after Botox the first few days. You should wait 10-14 days to see the final effect and then judge the result. I would advise you to have a two week follow up appointment with your injecting doctor to discuss your results.

Paul Vitenas, Jr., MD
Houston Plastic Surgeon
5.0 out of 5 stars 65 reviews

Botox Dose and Brow Drop

Ten units of Botox is a very small/conservative dose over the forehead. Two days after your treatment is very early and the full effect will take about 2 weeks to be realized. Wait until that time and make a follow up appointment.

Good Luck!

Dr. C

johnconnorsmd.com

John Philip Connors III, MD, FACS
Atlanta Plastic Surgeon
5.0 out of 5 stars 31 reviews

Botox takes 2 weeks...

Your botox hasn't reached it's maximum effect yet, that takes 2 weeks. At that point, if the problem persists, return to the same doctor who did the injections to see if you need a touch up.

Daniel J. Ladd Jr., DO
Austin Dermatologist

Droopy brow after Botox

Give it a little more time before you make any final judgment. Even if there is any asymmetry, this can be easily corrected with a minor touch-up injection.

Ryan Greene, MD, PhD
Fort Lauderdale Facial Plastic Surgeon
5.0 out of 5 stars 49 reviews

Botox - drooping

10 units is very conservative in the forehead.  I would recommend waiting a few days for the Botox to take full effect.  If one eyebrow ends up higher or lower than the other, usually a touch up can fix the asymmetry.

Dr. Cat Begovic M.D.

Catherine Huang-Begovic, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 10 reviews

Botox and Drooping

Regarding the drooping there are several factors to consider: 1) many patients have pre-existing asymmetries in brow p[position. If this is present, I point it out ahead of time so that the patient knows what to expect, 2) at 10 days, Botox has not reached its peak effect. I would re-evaluate the result in another week or two, 3) Botox treatment sometimes requires a little bit of titration or tweaking.  If you aren't happy in another week, go back and see your Dermatologist.

10 units of Botox is a relatively low dose for treating forehead lines.  My typical dosing for patients is 15-20 units.

Good Luck!

Stephen Prendiville, MD
Fort Myers Facial Plastic Surgeon
5.0 out of 5 stars 53 reviews

Can FOREHEAD Botox Cause Droopy Eyebrows? You Bet!

First, you need to wait 10 days for the final results.  Second, the forehead muscles have a resting tone that is in balance with the eyelid muscles.  When the muscles have been weakened by botox. the balance will be altered, and the eyebrows can drop.  In patients with very pronounced forehead lines, their forehead muscles are working hard to keep the eyebrows 'out of the way'.  I call this 'compensated brow ptosis'.  (It is the reason why just doing the eyelids alone can be a bad idea surgically, because in these patients, both the eyebrow and the eyelids have to be done at the same time.)  Some patients will have more activity on one side (in fact asymmetry is the norm, not the exception).  

Claudio DeLorenzi, MD
Toronto Plastic Surgeon
4.0 out of 5 stars 7 reviews

It is a bit too early to judge your results from 10 units of Botox

First, it is too early after the procedure to tell. You need to wait at least a week to see results. Further, 10 units is really a very, very small dose. I recommend a minimum of 30 units for the forehead, and 50 to get the best results. 

Peter Schmid, DO
Longmont Facial Plastic Surgeon
5.0 out of 5 stars 3 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.