Is it normal to only give Botox to the top half of a forehead? (photo)

Your injector is not incorrect in saying that one has to be careful injecting the lower half of the forehead as it increases the risk of a droopy eyebrow. That said, the lower half of the forehead can be injected with low doses of Botox to soften the creases, especially when the crows feet and 11-lines were injected in conjunction as well to help elevate the eyebrow and counteract and potential droopy ayebrow. You can discuss this with your injector and if you are not satisfied with him or her, it never hurts to seek a second opinion. Best wishes!

When I use Botox/Dysport in the forehead area, I tend to be fairly conservative until I get to know the patient and see how much they need in order to get the right effect.  I would rather they came back in a week for a little bit more than have them call me later and tell me they have heavy eyebrows.  That is the big risk with Botox/Dysport in the forehead.  Still, two inches above the eyebrows is too high.  You can get closer than that without running into any problems.  

The eyebrow arching or elevation depends upon multiple factors such as ethnicity, age,  strength of forehead muscle, glabellar complex and the muscles around the eyes.
The eyebrow elevation depends upon only one muscle on your forehead called frontalis and the eyebrow depression is controlled by multiple muscles. 
If some one has too many forehead lines and has horizontal eyebrow while raising the eyebrows could mean the Frontalis muscle is working very hard to elevate your eyebrows to fight against the strong depressor muscles. 
Yes your injector is careful not to cause the brow ptosis in your case. But remember if you relax the muscles in between your eyes and crows feet heavily, you will make the forehead lines much stronger.

Best Wishes
Dr. Shanthala

Thank you for sharing your question and photographs. I can appreciate the sentiment by your injector but oftentimes these lines of expression can be treated to achieve a more balanced and harmonious result with little effect to the eyebrows or eyelids.  This does depend on an in-person evaluation of your starting point.  If unhappy with the information or results you have obtained seek a second opinion.  Hope this helps.

From what you've said, it sounds as though the cosmetic surgeon's clinic you worked with were focused on tailoring the BOTOX® to your individual needs and providing the best possible results. This is far preferable to being treated with a one-size-fits-all approach, particularly as the professional you dealt with explained their decision. Of course, if you're not convinced, there's no reason why you can't consult another BOTOX® injector for a second opinion. If you do go down this route, make sure you're only consulting with a reputable, board-certified cosmetic surgeon's clinic.
 

Hi there. Sorry to hear you’re unhappy with your BOTOX® results. It’s difficult to tell from your picture whether or not you might see better results with lower injections. However, your plastic surgeon is right to be cautious about injecting BOTOX® right above your eyebrows, because drooping and sagging can occur. You might want to get a second opinion from another board-certified plastic surgeon to see if getting a low dose of BOTOX® in this area could offer the results you’re looking for. Wishing you the best of luck!

Thank you for your question. You submitted a single photo asking if it is normal to place Botox® only at the upper part of the forehead. You describe in your question a recounting of the dialogue you had with your doctor who stated they would leave about 2 inches above your brow in the areas that were injected to avoid losing full facial expression, and to avoid downward drop of the brows that would cause the eyelids to be heavy. It seems you’re still dissatisfied, and you feel “defeated” after all the money you spent.
I can share with you how I discuss this with my patients with similar situations like yourself, which are actually fairly common. A little background: I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial plastic and reconstructive surgeon. I have been in practice in Manhattan and Long Island for over 20 years. And I have been treating patients with Botox® since 1993.
One of the challenges we have to deal with up to this day has been patients who got over treated. When I say over treated, I mean well-meaning doctors who want to treat the wrinkles across the forehead. By doing so, they eliminate the mechanism by which the eyebrows can be elevated, which is used to help reduce the heaviness of the upper eyelids in the eyelid itself.
When we look at horizontal lines on the forehead, the question that first comes to mind is why are those lines relatively deep? Very commonly, beyond a certain age, it’s because unconsciously, people are raising their eyebrows because of the soft tissue and amount of skin descent of their eyebrows weighing down on their eyelids. They’re unconsciously keeping their brows up so they can see better. When they look at the mirror and see those lines, they’re distressed by them. Doctors will typically, or as I would do in my practice, I will have them look straight and relax their forehead. When their forehead is relaxed and I take their pictures, I’ll show them there’s so much extra skin over their eyes. We discuss other options in addition to Botox®. The Botox® can be done in a variety of ways to maintain some degree of tone so you maintain the ability to raise your eyebrows for natural expression and to prevent the full cascading of the skin over your eyelids.
Very often, once people realize they have all this extra skin over their eyes, we have a discussion of different brow lifting options and upper eyelid cosmetic surgery. What’s really nice is when people are aware of the fullness and heaviness of the skin over their eyes, a procedure like cosmetic upper eyelid blepharoplasty, which we do pretty much every day in our practice under local anesthesia with LITE™ sedation in our office Joint Commission approved facility, we’re able to reduce the amount of wrinkles on their forehead by diminishing or extinguishing the habit because they don’t have the weight over their eyes.
Interestingly, it still does take some Botox® to extinguish a habit. Very often, people still raise their eyebrows even after eyelid surgery, so it’s not a 100% immediate. Once they’re able to relax their forehead and don’t have to work so hard, then the schedule for Botox® can change, so they often don’t need as much. Maybe they need a little just to maintain a nice, natural look, but not as much to avoid the deep wrinkling of the forehead which comes from continuous contraction. Not to mention they also get fatigued from raising their eyebrows consistently. It’s like holding a weight up with any muscle - you can only do it for so long before you get fatigued.
As far as your doctor’s approach, I would say that’s a valid approach, and I think your doctor was certainly thoughtful in explaining what the basis was to help you achieve a natural result. There are pluses and minuses to being aggressive. I would say that once somebody is unable to move their forehead, or feels like their eyebrows are too low, and their eyelids are heavy, they’ll describe feeling trapped, and they’re very distressed and unhappy. Life is about compromise, and I do have to figure out with your doctor what you are willing to tolerate. Often in clinical medicine, it’s treat, then observe so you can see what kind of result you’ll have.
You can also compare your before and after photos. I always take pictures of muscles under activity, then relaxed, and show my patients how they look even after something as minor as Botox®. It’s very important to understand the activity of the muscles and how they would diminish. I always explain to my patients the definition of success is improvement. We can’t eliminate everything with just a needle, you have to decide what you’re comfortable with, and what you are ready to do now or later on. My patients tend to stay with me for a long time, and we may do Botox® for an important event, but later on like a year or 6 months later, we’ll do some surgery to address the underlying issue such as a hooding over the eyelids causing a reflex of raising the eyebrows which leads to wrinkles. Treat the underlying cause, and you can diminish the wrinkling in a long-term way with a strategy in mind. I hope that was helpful, I wish you the best of luck, and thank you for your question.This personalized video answer to your question is posted on RealSelf and on YouTube. To provide you with a personal and expert response, we use the image(s) you submitted on RealSelf in the video, but with respect to your privacy, we only show the body feature in question so you are not personally identifiable. If you prefer not to have your video question visible on YouTube, please contact us.

A heavy brow looks terrible and actually makes you feel tired. Injecting the lower forehead and the 11's on the same day, increases this risk of brow drop, especially if you have heavy eyelids.  If however, small injections are made more toward the eyebrows 2 weeks after the first injection is completed, the lines soften without the brow drop.

The more you relax your forehead the less expression you will have and more risk of brow dropping. Having said that I usually concentrate the Botox more centrally and then feather it out to the sides. This will give you more smoothing in the middle and still preserve your expression. you need to talk to your doctor about that fir the next time.

You certainly could have additional botox injected lower to help smooth out those wrinkles.  There is a danger of lid ptosis but only in a specific zone very close to the eyebrow.
Good luck