My question concerns the so called Mephisto effect from an injection with Botox.

Botox is a neuromodulator that is selectively injected into areas of the central brow and eyelids which helps to relax the muscles that cause wrinkles and lines, as well as reflexively lifting the outer brow. There are numerous positive effects of Botox, including lessening deep static lines with serial injections. Stretching the skin and causing bagginess is not a typical result with proper injection techniques. Try an experienced injector and start with a conservative amount.

Botox lasts 2-4 months and the results dissolve after.  you can get a pulled look if not injected properly.  Best, Dr. Emer.

The Mephisto sign occurs when Botox is injected I the forehead centrally, allowing the lateral portions of the frontalis muscle to raise the eyebrows unopposed. The eyelid skin you're referring to is not being "stretched" any more than when you simply raise your eyebrows. And if that skin is wrinkly and saggy with the eye brows down, then that means you may be needing a brow lift anyway. Seek a qualified plastic surgeon who can assess this for you in front of a mirror. I wish you the best!

The Mephisto sign and its closely related cousins, the dreaded Spock and Jack Nicholson look, are related to placement of Botox within the large muscle on the forehead called the frontalis. With misplacement, a portion of this muscle is not immobilized properly, which allows different forces to be placed on the brow, altering the brow shape. This does not, however, change the overall amount of force that this muscle is able to put on the brow that would "stretch it out," and actually decreases the overall force, reducing wrinkles in the long term. If there is a shape change in the brow, it can be  corrected with a subsequent touch up treatment by a skilled injector. 

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.

Cameron Chesnut#realself500 Physician

Good question. Botox does not stretch skin. However, when giving Botox for migraines, the eyebrow can drop, giving more upper eyelid fullness. This should be discussed as a consequence of migraine relief with Botox. Frequently, we perform upper blepharoplasty to eliminate the fullness.