Drooping Eyebrow After Botox

Dear Dermaqueen
It is my experience that the effects of BOTOX begin to be evident at 2 to 3 days but are not at their maximal effect until about three weeks after treatment. Then the effect is sustained for about 3 months and then begins to rapidly diminish. Unwanted side effects may not persist nearly this long because generally, these are typically caused by only a tiny fraction of the total treatment.
However, brow drop is a 100% predictable result of injecting BOTOX into the forehead. The muscle up there makes the forehead lines but also lifts and supports the eyebrows. The position of the eyebrow is determined by a tug of war between the brow elevators and the eyebrow depressors. I actually due a treatment I call MicrodropletTM BOTOX where I extensively only treat the eyebrow depressors. My technique allows me very precise control over the placement of the BOTOX. By just treating the eyebrow depressors and leaving the forehead lifter alone, a significant, naturally looking lift in the eyebrows results. I am applying for a patent for this method.
As your treatment sets in the asymmetry may or may not persist. Your doctor can adjust the asymmetry with a little more BOTOX in the forehead. The doctor is welcome to review my technique but should be careful of using it on you. The treatment method is often counter intuitive to doctors who are use to paralyzing things and are uncomfortable with using small doses of BOTOX to balance things.

Hi DQ.  A droopy brow is one of the side effects of Botox injections.  Although it does not happen often for experienced injectors, it can happen when the solution migrates from the muscle group that the drug is intended to relax to an adjacent muscle group.  With eyebrow droop, we can sometimes fix it if we relax the crows feet but it seems you had that done at a previous injection.  You should visit your injector for feedback, but you may have to wait 1-2 months for the area to improve. 

Eyebrow drooping after neuromodulators like Botox, Dysport or Xeomin is a rare but well described issue, usually resulting from product placement or the amount used. 
The first thing that needs to be determined is whether it is a droopy eyebrow or a droopy eyelid. Droopy eyebrows are much more common and result from over-immobilizing the only muscle on the forehead that is able to lift up our eyebrows - choosing the right amount and placement in the right patient is key to good forehead results. Droopy eyelids come from the product getting into the wrong muscle that elevates the eyelid. 
Management of them is quite different, but both have strategies to help expedite resolution while waiting for them to resolve with time, and any experience injector should be very familiar with how to deal with them: drops for the eyelids and precise placement of Botox in the brow depressors when it is an eyebrow issue. 
To ensure you are receiving the highest level of care, seek out a modernly trained, new-school dermatologic surgeon, oculoplastic surgeon, facial plastic surgeon or plastic surgeon who is board certified and fellowship trained in one of these "core four" cosmetic specialties. Membership in organizations like the American Academy of Facial Plastic and Reconstructive Surgery help to identify a highly trained surgeon.
Cameron Chesnut#realself500 Physician

So, the good news is that Botox is NOT permanent and although the full effects of Botox typically last 3-4 months, muscles that are inadvertently affected (as in your case) typically receive less of a dose and I predict your brow will likely return sooner to its pre-injection state...The key is what do now…A droopy eye-BROW from Botox can sometimes be improved with Botox injected into the outside part of the eye (the lateral aspect of the orbicularis oculi muscle) to generate a bit of a brow lift in that area – by paralyzing the orbicularis muscle that normally acts to depress the brow, you may get a slight compensatory brow lift with Botox to that area.  In the future, be sure to 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, 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 and see the actual muscles themselves. For me, this helps guide where to inject and where not to. However, with that said, I know many Dermatologists who know the anatomy well despite not operating in that area, and get great results.Good luck.

One of the risks of botox treatment is that muscles other than those targeted can be affected by the treatment. That risk is less likely when your treatment is performed by an experienced doctor. Botox treatment's effects are temporary. Because non-targeted muscles do not receive the full dose of your botox treatment, the effects in non-targeted muscles typically resolve well before the effects in targeted muscles. There is no way to immediately reverse the effects of botox. In some cases, unintended asymmetry may be amenable to improvement by performing a touch up treatment on the other side. Always discuss your concerns with your doctor. Good luck.

Notify your doctor but do nothing for two weeks.
I have seen Botox over correct for the first two weeks and settle down after that.
If after two weeks your eyebrow still droops there are a few options:

If your eyelid is also drooping, there are eye drops (one is alphagan) which can stimulate the eyelid to elevate but this will not effect the eyebrow.
If your eyebrow still droops, injection of Botox below the tail of the eyebrow may ease the depressor effects for the orbicularis oculi
Alternatively, you may choose to lower the opposite eyebrow to make them more even.