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Brow Drop and Hourglass Deformity from Botox - Halifax, NS, Canada

I tried Botox a couple months ago (Botox brow...

I tried Botox a couple months ago (Botox brow lift). The idea was to increase the arch, lift the brows a bit / widen my eyes. I thought that if I went to an experienced doctor, I would decrease my chances of having a bad experience. Clearly my logic was flawed.

Injections were done between the brow, and above the outside of my brow (see attached photo). Amounts were 20 units in the central area, and 2.5 units on either side.

A few days after the treatment, I noticed that there was a bit of lift in the inner part of my forehead, and my frown muscles were deactivated. However, the outer part of my eyebrows had dropped significantly, making my eyes look hooded / sad, and sunken. My brow was completely flat and masculine - absolutely no arch whatsoever.

This was the exact opposite effect of what I wanted, so I went back after 2 weeks. He put more Botox in either side above the outside of my brow (3 units on either side; see attached photo). This did not help at all, so I called back after a couple more weeks. I did not want to get more injections, just wanted to see the doctor and show him what had happened, and try to determine why. The girl who answered the phone condescendingly told me that "it's too bad it turned out like that", and "some people just don't like how Botox looks", and that I could not make an appointment until after it has worn off.

A few months later, it has started to wear off, and my frontalis muscle has regained most of it's strength. My eyebrows still look kind of wonky and crooked when I raise them, but at least I can raise them again.

In addition to the dropped brow, I've recently noticed a dramatic decrease in volume in my temples. Considering that I am vain enough to try Botox, if I had this issue before I would have noticed. It gives my head a hollow, sickly, old look. This type of aging is not typical of someone who is under 30 years old.

Interestingly, after doing some online research I have discovered that "Hourglass deformity" - a caving in of the temples due to muscle loss - is a reported side effect of Botox use (B. Guyuron, K. Rose, J. S. kriegler og T. Tucker, 2004. Hourglass deformity after botulinum toxin type A injection. Headache 44, 262-264.)

Apparently this muscle loss is temporary, and the volume should come back on its own now that the Botox is wearing off. I am not sure how long this will take. I have taken up chewing gum as an effort to work the temporalis and hopefully hasten the muscle regrowth.

The Botox use mentioned in this article was to treat migraines, however the area where I was injected could have definitely resulted in Botox in the temporalis muscle. I also suspect a large amount of Botox made its way into my frontalis muscle. I believe that too much botox was used, and that the injection sites were incorrect for my anatomy.

According to the research I have done on this topic, the orbicularis oculi (just inside the outer brow) is a better injection site for the brow lift effect. I am not sure why this doctor chose to inject in the temporalis and frontalis.

Would I try it again?

Maybe, but definitely not with this doctor, and definitely not in the same injection sites. I don't think the Botox was the problem, but rather the poor technique.
Prefer not to say

2 out of 5 stars Overall rating
4 out of 5 stars Doctor's bedside manner
1 out of 5 stars Answered my questions
1 out of 5 stars After care follow-up
1 out of 5 stars Time spent with me
1 out of 5 stars Phone or email responsiveness
1 out of 5 stars Staff professionalism & courtesy
2 out of 5 stars Payment process
4 out of 5 stars Wait times
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Comments (11)

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Did the hourglass deformity go away? If so, how long did it take. I am 9 weeks postbotox to glabella and crows feet with a major loss of temple volume and sunken in cheeks.
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Hi Tosha, same thing happened to me! Im still living with the bad results now (nearly 2 yrs on) how are you now? Have you seen any improvements?
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So sorry to hear that I cant believe 2 years... how depressing. Have you seen any improvements? Also, did you continue to get worse after the 6 month mark or did things sorta level out at that point? I just do not want to get any worse. I have cheek droop major wrinkling under eyes with lines going down my cheeks when I smile. Caved in temples. I look so hot right now LOL Any feedback would be helpful. Have you seen any improvements or are you just not back to baseline?
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Hey T :). Haha yeh VERY depressing. Ive seen very minor improvements (As in, the botox is finally starting to disappear from my face.) Yes, it got a lot worse :( Ive got horrendous lines that extend down my cheeks, caved in temples, cheek ptosis/droop, indentations, and severe muscle atrophy with saggy skin, oh and sunken in hollow eyes that look like i havent slept in a million years lol. Its bad... I would say that iv seen the most improvement over the last month. Im no where nearer to the face i once had. But I have to stay hopeful. How long ago was you injected??
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BB- You are at 2 years, when did it stop getting worse? Did you have all of the issues at 6 months or did they happen. When did it stop getting worse?
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I couldnt lift my eyebrows for approx 6-9 months (had to lift them manually to put mascara on.) -Then it started to wear off a short time after and I was finally able to put mascara on without havin to use my fingers to lift my brow. The indentations; I noticed 3 days after, and i still have them. sunken in eyes (again 3 days after) -still have them now, but not as bad. Id say they looked less sunken after about 14months. cheek droop is better, but not back to normal yet. They started to rise slightly again at about 12-14 months Hollow/caved temples are exactly the same as 3 days after I had botox, -just very minor improvements regarding the temple area. It just got worse and worse as time went on, and it finally came to a sorta stop at around 14-16 months. the botox is finally starting to disappear, but its left me with disgusting saggy skin (because of how much my muscles have atrophied)
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Tosha. its my eyes that upset me the most.. They look like an old womans eyes! Empty, saggy, hollow with horizontal lines that extend down my cheeks. They have improved over the last two yrs, but jeeez its slow babe it really is. Judging by my recovery (if you can actually call it that) I honestly reckon iv got another year atleast. Its completely ruined my social life, deactivated all social media sites (couldnt bare looking at pics of me, because I dont look like the same person anymore) -well I do, but 10yrs older. Dont worry though by thinking it'll take you as long as me for recovery, everyones healing process is different. So keep your chin up, and try not let it grip you like it has me, because it becomes an obsession. I can honestly say, I wake up every morning, and the very first thing i do is look in the mirror for changes.. -been doing that every single day since july 2012.
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I've been having Botox injection from my neurologist for almost a year, and I've never had an hourglass type of side effect. In fact this is the fist time that I've ever heard of it. You're right, you should go to a different doctor next time.
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just one comment: if the physician is good he will not overload or catch the wrong muscle... he evidently caught the opposite muscle around your eyes generating that bad effect.... even the lightest drug, if used improperly can become dangerous... even sugar to a diabetic :) or a nut to an alergic.. it's all about how things are used, explained and delivered :) I am having botox every 8-9 months since 2008 and I am so happy, when I do it people simply note that I look not tired.. which is why I do it.. nothing destructive or excessive... My physician is one of the best plastic surgeon in Italy... not a simple nurse...
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Very interesting article, Anothony. You've got me hooked up - keep up the nice work! thermage skin tightening
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Thank you very much for sharing all of this with us. I'm sorry you had a rough first experience. :(

I had heard very little about Hourglass Deformity previously, so I'm glad you brought it up. Since the study you found was specifically for migraines it made me curious if the deformity is seen with cosmetic use or if it is somehow specifically related to use for migraines. I submitted this Q&A to see what some of the board certified doctors who volunteer on RealSelf had to say. I thought it might be of interest to you so here is a link if you want to follow it with me:

Is Hourglass Deformity (Hollowing in the Temples) Seen in Cosmetic Use or Only Migraine Treatment?

Also, if you have any before pictures I would love it if you would share them.

Keep us posted on how your temples are looking, and how you are doing!

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