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

Question

I recently got Botox for my deep horizontal lines. The dr said he had to leave 2 inches above my eyebrows so that I wouldn't get a heavy brow since I have a prominent brow and expressive face. (I guess) He said I would not be very unhappy with the results and my eyelids could droop and feel heavy. I respect that he could have just done it but didn't. I'm curious if I should get a 2nd opinion. I just can't believe I'll never get rid of these wrinkles! And for all that money. feeling defeated.

Thomas J. Walker, MD, FACS · Answer

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!

Edwin C. Pound, III, MD · Answer

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.

Shanthala Shivananjappa, MD · Answer

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

Nelson Castillo, MD · Answer

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.

James R. Koehler, MD · Answer

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.

Lee B. Daniel, MD · Answer

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!

Mary P. Lupo, MD · Answer

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.

Michael L. Schwartz, MD · Answer

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.

Aaron Shiloh, MD · Answer

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

Melvin Elson, MD · Answer

in actuality the injection of the forehead is just one muscle--the frontalis--but if injection is done too close to the eyebrows ptosis may result. However, 2 inches is far too much so that you can have injections lower. be sure to see a board certified dermatologist

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