Hoping to Correct Flat Eyebrows/harsh Look from Botox: What is the Likelihood of a Successful Outcome?

Question

First time ever Botox injection 5 days ago for horizontal forehead lines. 40 yo. I did raise my forehead for some lift. Naturally-arched brows have gone flat, forehead appears slightly dropped (or maybe it's the brows) making for a harsh, manly look. Outer brows slant down slightly. Brows immobile except for inner brows shooting up. Cartoonish. Think Snoopy dancing when brows jump off face! I called the office, they said come back, it's easily lifted with a few small injections. I am terrified!

Donald B. Yoo, MD, FACS · Answer

With over-treatment of the frontalis muscle (the muscle within your forehead which raises your eyebrows), the brows can become ptotic (droopy).  Although you won't achieve full correction of this unwanted look until the Botox wears off in 3-4 months, it is possible to raise the brows slightly with additional injections.  Injecting the muscle at the lateral aspect of your brows/eyes (orbicularis oculi) will lift your brows somewhat.

Richard Baxter, MD · Answer

Horizontal lines in the forehead develop because the muscle that elevates the eyebrows is hyperactive. The main reason becomes overactive is when it is working to hold the brow up to compensate for heavy eyelids. So relaxing the forehead muscle (frontalis) allows the brow to drop back down, making the lids appear heavy and flattening the brow shape. Sometimes it is possible to balance this effect by treating muscles that pull the brow down but it requires good judgment and technique. Return to your injector and give them a chance to evaluate.

Sam Naficy, MD, FACS · Answer

You sound like you're experiencing the effects of brow ptosis - which is as a result of too much product injected in the forehead (frontalis) and/or poor placement. I would follow up with your provider to have them assess before retreating.

Melissa Chiang, MD, FAAD · Answer

Botox has paralyzed your forehead muscle (called "frontalis").  Frontalis lifts the brows.  Since frontalis is no longer lifting, your brows have dropped and may feel heavy.  Sometimes people also complain that their eyelids have become more hooded or heavy.  

	Once botox has paralyzed a muscle, you need to wait for the botox to wear off in order to regain the function.  Oftentimes, people have improvement within a few weeks.  

	If you return to the office, they can use additional botox to paralyze the inner brows.  In addition, they can also use botox on the muscle that surrounds the eye to try to get your arch back.  That muscle (called obicularis oculi) pulls the brow down, so when it is paralyzed in the right place, the brow lifts.  

	Good luck.  I would definitely return to at least see what your injector's thoughts are.  You don't have to have additional treatments, if you are too scared.  Also, if you did not go to a dermatologist, plastic surgeon, or facial plastics surgeon, you may want to consider going there for an opinion.

Paul Carniol, MD · Answer

It is unfortunate that you have had this result from Botox.  This flattening or drooping is time limited.  It should resolve within six weeks to three months without further treatment.

Considering this, do not treat it further as with additional treatment there is a risk that it may get worse.

(If this problem does not resolve within a few months then you should see a neurologist.)

Most likely this occurred due to the dose and/or location of the Botox injections.  However, it is possible that you are particularly sensitive to Botox and that this problem could develop from another treatment.

Recommend that you see a different physician for any further Botox treatments and that before the treatment you explain to the physician what happened with this treatment.  Furthermore before the new physician treats you ask what the physician is going to do to avoid this problem occurring again.

Hoping to Correct Flat Eyebrows/harsh Look from Botox: What is the Likelihood of a Successful Outcome?

Answers (9)

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Answer: Correction of brow ptosis after Botox injection

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Hoping to Correct Flat Eyebrows/harsh Look from Botox: What is the Likelihood of a Successful Outcome?

Answers (9)

Answer: Correction of brow ptosis after Botox injection

Answer: Correction of brow ptosis after Botox injection

Answer: How to balance effects of Botox in the forehead

Answer: How to balance effects of Botox in the forehead

Answer: Botox and forehead heaviness

Answer: Botox and forehead heaviness

Recommended reading

Everything you need to know about Botox

Answer: Botox touchups - return to your provider

Answer: Botox touchups - return to your provider

Answer: Undesirable result from Botox in the forehead

Answer: Undesirable result from Botox in the forehead

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