Will my eyes ever go back to normal after botched Botox? (Photo)

Question

I got Botox about a year ago. My eyebrows were dramatically uneven. I went back and was told he could Inject more but no guarantee they would even out. Now, a year later, my eyes are still wonky. I am assuming the muscle on the opposite side is much weaker and still doesn’t move. Is this the problem? How can I fix this??

Brian Maloney, MD, FACS · Answer

Uneven brows a year after BOTOX are due to your natural asymmetry. The whole face forms from two separate halves. So we all start out life with differences between the two sides.Over time from sleeping on a certain side or even driving in the car the two sides will continue to look even more different.

Steven H. Williams, MD · Answer

Hello and thank you for your question. Botox generally last for three to four months, so it is very unlikely for any effects to last this long. I would consider comparing current pictures with pictures taken  before you received botox, so you can determine if this issue is new or pre-existing. Botox can be used to make brows more symmetric, so I would meet with an experienced, licensed injector to discuss further. I hope this helps!

James R. Gordon, MD, FACS, FAAO · Answer

Thank you for sharing your question and posting your photograph. It is very unusual for results following Botox injections to last more than a few months. You might have ptosis (drooping) of the left upper eyelid which is causing the brow on that side to pull upwards. See an experienced Oculoplastic Surgeon for comprehensive evaluation and discussion of treatment options. Good luck!

Elham Jafari, MD · Answer

Hi and thank you for your question! The effects of Botox generally last for a few months and it is rather unusual for any unwanted effects to last for over a year. I highly recommend that you do an accurate and objective picture analysis (comparing current pictures with pictures obtained before the treatment, or even older persona pictures you might have) to be able to determine what issues are new/post-treatment and which issues were pre-existing. Generally speaking, we can use Botox to treat and adjust uneven eyebrows, but as said before, the effects are also temporary and need repeat treatment. You might also want to consider other eyebrow lift procedures such as Ultherapy to try and make them more even. I hope it helps and good luck!

Camille Cash, MD · Answer

Botox can help with brow asymmetry to a degree.  If the asymmetry is more moderate to severe a brow lift would be indicated.  A year after your Botox treatment the product effects will have worn off.  The treatment results typically last three to four months and fade gradually.

Carmen A. Traywick, MD, FAAD · Answer

Botox lock the release of a chemical called acetylcholine, which triggers the muscle contractions that create wrinkles. Botoxessentially paralyze the muscles and stops them from contracting. Results from these treatments are visible within 3-7 days with results that can last anywhere from 3-4 months. Hope this helps.

Monika Soni, MD · Answer

The effects of Botox generally last for a few months and it is rather unusual for any unwanted effects to last for over a year. I highly recommend that you do an accurate and objective picture analysis (comparing current pictures with pictures obtained before the treatment, or even older persona pictures you might have) to be able to determine what issues are new/post-treatment and which issues were pre-existing. Generally speaking, we can use Botox to treat and adjust uneven eyebrows, but as said before, the effects are also temporary and need repeat treatment. You might also want to consider other eyebrow lift procedures such as Ultherapy to try and make them more even.

Leonard Grossman, MD · Answer

This may be a bit of a disappointment to you but every single individual has assymmetry that is very similar to yours. I would urge you to look at your photographs long before you had Botox and your current ones and I'm sure you'll find the same relative anatomy in the face. Good luck from New York City

My Botox LA Med Spa - Account Suspended · Answer

Hi, thank you for your question. Botox is a temporary solution to help lift eyebrows and make them look more symmetrical. If brow’s are uneven, we use more units on the side that is lower and requires more lift. It is a limited lift and at times may not make the both brows look totally symmetrical, but it definitely improves the overall appearance of the droopy brow. Botox will usually last on average 3 months and will not leave any residual or unwanted changes 1 year later. For a better evaluation of uneven brows its best to compare a good before and after picture while relaxing your face. We would recommend a consultation with a facial plastic surgeon for a more permanent solution. Hope this helps and good luck.

Alex Eshaghian, MD, PhD · Answer

Thank you for your question and for sharing your photograph Skindarling. I understand your concern. Botox is a purified protein used to address wrinkles associated with facial expression. When injected into the skin Botox will relax the muscles and smoothen out the overlying wrinkles. The most common areas of treatment are in the upper face. These include the horizontal lines seen on the upper forehead when one raises the brows, the vertical lines seen between the brows when one frowns (frown lines), and the crow's feet seen around the eyes when one smiles.It is difficult to make an assessment in the absence of consistent photographs before and after in the same lighting and angles for comparison. However, I hope the information provided here is useful.The pivotal studies used 20 units of Botox in the forehead area above the brows to address the horizontal lines seen when one raises the brows. These studies demonstrated that the peak results are seen 14 days after the treatment and most people enjoy their results for 3-4 months. At that point, a maintenance treatment is recommended. While some people start to see results as early as the next day, it can take two weeks for full results so patience is important. We have our patients return two weeks after their treatment to assess their results via photographs. At that time additional units may be added if necessary.The pivotal studies for the horizontal lines on the upper forehead were published many years after doctors had been using Botox. In these studies, 20 units of Botox were used to treat this area. However, in my experience I find that anywhere from 10 to 20 units works well in this area. For patients with narrow foreheads a lower dose may be used and those with a broad forehead generally require higher doses. I have also found that the full results in this area are seen by two weeks. Therefore, we have our patients return two weeks after their treatment to assess the results via photographs. At that point additional units may be used if further enhancement is desired.When patients present with concerns about specific wrinkles in the upper face such as the frown lines, I always assess and usually treat the other wrinkles in the upper face including the horizontal forehead wrinkles and crow’s feet. The reason is to maintain a harmonious and natural balance to the appearance of the upper face. The muscles in the glabella which are responsible for the formation of the frown lines serve to pull down on the inner brows when a person frowns. Similarly, the muscles around the eyes which are responsible for the formation of the crow’s feet seen when smiling (orbicularis oculi) are also responsible for pulling down on the brows, but in this case the outer brows. On the other hand, the muscle in the upper forehead which is responsible for the formation of the horizontal forehead wrinkles when a person raises the brows (frontalis) serves to pull the brows upward. If one of these muscles is relaxed with Botox and the others are not, the other muscles will still be active. This will lead to an unbalanced and unnatural appearance of the upper face where the brow can be elevated, depressed, or uneven in shape or position. Therefore, I recommend that my patients take a global approach to the upper face when receiving Botox treatments and treat all three of these areas. Sometimes bunny lines on the bridge of the nose are also treated.When Botox is used in the upper forehead, if the dose is too high or the placement is too low it can result in the feeling of heaviness in the eyebrow or even lower the position of the brow. In order to reduce the risk of this possibility, I use a conservative dose in the area and place the product high on the forehead, sometimes near the hair line. Additionally, I recommend that my patients simultaneously receive a small amount Botox between the brows and at the corners of the brows. This will relax the muscles that pull down on the brows to counteract this effect and provide a harmonious balance to the position of the brow. The results are assessed two weeks after the treatment. If there is any asymmetry a small amount of Botox can be placed in the upper face for correction.Sometimes after a Botox treatment a peaked appearance of the eyebrow is seen. This is sometimes called the Spock or Mephisto look, which makes a person appear surprised or sinister. It is also called the Jack Nicholson look, after the appearance of his eyebrows. This can occur if the muscles that pull the eyebrow down are relaxed with Botox. It can also occur if the upper forehead only is treated. In this case the inner portions of the muscles are relaxed preferentially over the outer portions of the muscle. This allows the outer portions of the muscle to pull up on the tail of the eyebrow. While some people desire this appearance, others do not. This effect can be corrected by placing a small amount (1-2 units) of Botox in the upper forehead approximately midway between the eyebrow and the hair line at the peak of the brow. This relaxes the muscle that pulls up on the tail of the eyebrow, thereby restoring a natural appearance.With any injection, there are risks such as pain, bleeding, bruising, redness, swelling, tenderness, and infection. We take special precautions to minimize these risks such as using a painless technique. We also treat bruises with a laser as early as the next day. Bruises usually resolve within two weeks if untreated. After a laser treatment bruises usually resolve in 1-3 days, but may still take two weeks for full resolution. In addition to these risks, with Botox there is also a risk that the product spreads or diffuses to nearby structures. Spread to nearby muscles can lead to side effects such as the temporary appearance of droopy eyelids or a temporary asymmetric smile.
After a Botox treatment, I recommend that my patients avoid heat exposure, alcohol consumption, and strenuous exercise for 24 hours and not lie down flat for four hours. This is because all of these activities may possibly lead to the movement of the product and consequent side effects such as droopy eyelids. Although there have been no definitive studies shown that these actually occur and some physicians do not provide such aftercare instructions, in the absence of data I err on the side of caution and recommend that my patients avoid such activities.
  
Please consult with a doctor for specific recommendations. Good luck!

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