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I Have Uneven Eyebrows, Will Botox Fix This? (photo)

I have uneven eyebrows, although when I smile, they even out. (Why is that??) I had to have stitches above my right eyebrow when I was younger and ever since, I have had nerve pain and numbness in that area. You can see the indent and scar tissue above/to the edge of my eyebrow. I'm wondering if this is why my eyebrows are uneven or is it my left eyebrow that is too low? What could I get done to fix this? Thankyou.

Doctor Answers (8)

Botox for Uneven Eyebrows

+3

Yours is an interesting problem, and thanks for including the photos.  I'll bet you get some different opinions from the experts on this forum, and there likely is not one single correct answer.

Numbness and nerve pain indicates that you probably sustained an injury to the supraorbital sensory nerve on that side.  You may also have some minor facial motor nerve damage,or the scarring may be releasing the downward pull of the orbicularis muscle on your right side, making the lateral brow higher.  Botox injected into the lateral brow area on the opposite (left) side will give a slight elevation and likely will get the height more symmetric at rest.  In addition, the scar on the right, which appears to be depressed in the photo, might be able to be made less conspicuous by injection of a hyaluronic filler, such as Restylane or Juvederm.

There is also slight asymmetry of your upper eyelids, making your right eye look a little smaller when you smile.  This is not amenable to correction with Botox, but there are other options (which are beyond the scope of this discussion).


Manchester Facial Plastic Surgeon
5.0 out of 5 stars 10 reviews

Uneven eyebrows and botox

+2

My eyes were immediately drawn to your scar in your photograph. Upon enlarging the photograph it is apparent that there is a contraction of tissues creating soem contour irregularity.  The contraction of the healed wound when you were younger has pulled up on the outer corner of the eyebrow. You have lost the normal mid eyebrow elevation of the arch and the scar pulling gives you a slight  "stern" appearance by raising the corner of the eyebrow.  You have less redundancy or "hooding" / blepharochalasis of the right upper eyelid than the left because of the right eyebrow lift.

I don't think botox will help relax the scarring in the tissues or relax the muscles of the right forehead to lower the right eyebrow.  You could have a scar revision with a "Z-plasty" to lower the corner of the right eyebrow and if hooding then occurs, you could have a blepharoplasty (eyelid tightening) on both sides.

The reason the eyebrows look similar when smiling is because you use both the eyelid and smile mouth muscles when smiling and the periorbital eyelid muscle, when contracting, encircles the eye and the outer component pulls down on the outer corner of the eyebrow (that's why we inject that area with botox off-label, to help give a lift when needed). 

Ronald Shelton, MD
Manhattan Dermatologist
5.0 out of 5 stars 31 reviews

Botox for uneven eyebrows

+2

While the injection of botox to the outer fibers of the orbicularis occuli muscle of the left side can result in elevation of the left eyebrow, the degree of elevation would be unpredictable and may not match the right side consistently. It would seem the right eyebrow is elevated to compensate for a mild ptosis. If you feel compelled to do something about this situation, a consultation with an occuloplastic surgeon would be good starting point.

Sanusi Umar, MD
Redondo Beach Dermatologic Surgeon
5.0 out of 5 stars 23 reviews

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Uneven eyebrows

+2

The reason your eyebrows look more even when you smile is the crows feet muscles are pulling your brows down. You are starting off with a right eyebrow that is higher, I do not believe it is due to any injury to the muscle of the forehead where the depression is as if it were, and then the brow would be lower, not higher. I do think than an evaluation by an ophthalmologist prior to any Botox would be a good idea to see if you have a weakness of the eyelid levator muscle itself that can cause a reflex subconscious elevation of the right eyebrow.

Julio Garcia, MD
Las Vegas Plastic Surgeon
4.0 out of 5 stars 6 reviews

I Have Uneven Eyebrows, Will Botox Fix This? (photo)

+2

You have uneven eyebrows, but you also have uneven eyelid heights.  Your right eyebrow is higher then the left and your right upper eyelid is lower then your left.  Probably what is happening is that your right eyebrow is elevating to try and open your right upper eyelid more.  Botox can change the eyelbrow heights, but it might exacerbate the asymmetry between the upper eyelids.  See an Oculoplastic surgeon to best determine what your options are.

Sam Goldberger, MD
Beverly Hills Oculoplastic Surgeon
4.5 out of 5 stars 15 reviews

I Have Uneven Eyebrows, Will Botox Fix This? (photo)

+2

Thanks for the posted photos. Try Botox first on right supra orbital area. If happy than continue this every 6 months as  needed. If not happy, look into surgical lifts either threading, Endotine, unilateral endo/open lift, direct eyebrow lift incision, etc. But BEST to see a few boarded PSs in person in your area. Follow up would be nice. 

Darryl J. Blinski, MD
Miami Plastic Surgeon
4.5 out of 5 stars 64 reviews

You arch the right eyebrow to compensate for right upper eyelid ptosis.

+2

Notice how the right upper eyelid is just a bit heavier than the left upper eyelid.  The right upper eyelid margin hangs into the cornea about 1 mm more than the left upper eyelid sits on the left cornea.  To compensate for this, the forehead muscle is working just a bit more on the right side than on the left.  This most likely accounts for the difference in appearance.  BOTOX might help balance this.  However, I recommend being assessed by an oculoplastic surgeon to determine you best treatment options.

Kenneth D. Steinsapir, MD
Los Angeles Oculoplastic Surgeon
5.0 out of 5 stars 17 reviews

Even eyebrows and botox

+2

Many people have uneven eyebrows heights.  In your case the scar tissue above your right outer brow may be causing some tethering of the tissue between the brow and the scar.  When you smile, your muscle that depresses the brow may be be brining the outer brow down.  You can consider putting 3-4 units of botox just below the outer left brow.  This will help elevate the left outer brow when you are not smiling.

You can also consider adding a little in the same place on the right side, but i would do this sequentially.  The reason for putting some on the right side as well is to get symmetry when you smile.  The scar you have from your  past injury may limit how much the brow elevates when you are not smiling.  Hope this makes sense.  Good luck.

Young R. Cho, MD, PhD
Houston Plastic Surgeon
5.0 out of 5 stars 10 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.