How can a dropping eyebrow be corrected? (Photo)

Question

18 days ago I had Botox - 11 and one side of the forehead On day 7th I have noticed severe drooping on the treated side. 18 days since the original injection and 6 days after the brow injections to correct the drooping problem, the brows look differently near the nose and also, I have the eye “half open”. The specialist who was doing the 2nd set of injections (eyebrow) said that she doesn’t think the eye drops will be effective. Basically, what do I do from here to alleviate the problem?

Jason Emer, MD · Answer

This can be improved with a combination of Iopidine, venus legacy and thermage treatments. Botox results resolve in 3-4 months. See an expert. Best, Dr. Emer

Kristin J. Tarbet, MD, FACS · Answer

I find that Iopidine (0.5% solution drops) do help. You will begin to recover some of the muscles strength within the first 3 weeks post injection with the balance fading up to 3 months post injection. Bummer for anyone to get a droop but it does occur. Good luck to  you!

Alex Eshaghian, MD, PhD · Answer

Thank you for your question and for sharing your
photograph mdatx. 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.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.The muscles that are treated with Botox around
the eyes are close to the muscle that lifts the upper eyelid. If this muscle is
affected it can lead to a temporary droopy eyelid (blepharoptosis). The
duration depends on the placement of the product and the dose used. Usually it
resolves in 2 weeks, but it can last up to 4 months. Blepharoptosis can be
treated with apraclonidine 0.5% ophthalmic solution (also known as iopidine)
and various other medications. For my patients, I recommend 2-3 drops to the
affected eye 2-3 times per day. When the blepharoptosis begins to wear off
patients notice less of a droop when waking up in the morning after the last
dose of apraclonidine has worn off. The incidence of blepharoptosis is reported
to be approximately 1% but in my experience, I find it to be about 0.1%. This
is likely due to the fact that when these studies were initially performed
injectors may have not been as aware of this adverse effect nor been taking
extra precautions to avoid it. Blepharoptosis occurs when Botox is placed near
the eye and it diffuses to the muscle that lifts the upper eyelid (levator
palpebrae superioris). This is located inside of the orbital rim above the
globe. To avoid this side effect, I place the product at least 1 cm from the
orbital rim. When placing product between the brows I pinch the area to be
treated and lift it so that the product is placed in the muscle and is less
likely to diffuse around the bone into the orbital space. Diffusion into this
area may also be caused by other preventable things. For this reason, I
recommend that my patients carefully follow the simple aftercare instructions
described below. This may be a reason for the low incidence of side effects in
my practice.If I had a patient who looked like the person in this photograph I would say she is a good candidate for using apraclonidine ophthalmic solution.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 as described above. 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!

Melvin Elson, MD · Answer

Iopidine drops will help elevate the lid while it is improving on its own. Do not opt for expensive treatments fior a temporary problem

Shaun Patel, MD · Answer

Unfortunately, I think you will need to wait for the Botox to wear off before your eyebrows/eyelids return to their normal position. This can take 3-4 months although you will start seeing some improvement sooner then that. This complication typically occurs when too high of a dose is used for the forehead or the Botox is placed too close to the eyebrows.

How can a dropping eyebrow be corrected? (Photo)

Answers (6)

Answer: Drooping eyuelids

Answer: Drooping eyuelids

Answer: Eyebrow ptosis after Botox treatment

Answer: Eyebrow ptosis after Botox treatment

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How can a dropping eyebrow be corrected? (Photo)

Answers (6)

Answer: Drooping eyuelids

Answer: Drooping eyuelids

Answer: Eyebrow ptosis after Botox treatment

Answer: Eyebrow ptosis after Botox treatment

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Recommended reading

Everything you need to know about Botox

Our mission is to create a world where every investment in modern beauty is Worth It.