How to avoid mephisto lines when treating forehead wrinkles with Botox? Would a filler be a better solution? (photo)

Question

I am 28 and have some light, but visible fore head wrinkles. I went to get Botox, and after 3 days my wrinkles completely disappeared, but my inner eyebrows sagged.Doctor said it wasn't avoidable to have that so called "mephisto-effect". I move my eye brows a lot (that is probably also a reason for my forehead wrinkles), and that I couldn't raise the inner part anymore, plus that it was sagging, really bothered me. Is there a method to reduce those wrinkles without affecting my eyebrow-muscle?

Houtan Chaboki, MD · Answer

The "Spock" or "Mephisto" effect, where the eyebrows become more arched, can happen after Botox cosmetic treatments in the forehead and around the eyes. This effect is temporary and may be due to the technique of the injector or a patient's inherent muscle activity. Additional Botox can help relax the arched eyebrows for smoother result. Some plastic surgeons or dermatologists have patients return after a couple weeks for touch-ups as needed. Filler in the forehead area is generally not used for many reasons. Best,Dr. Chaboki

Nelson Lee Novick, MD · Answer

In medical lingo, the results achieved with Botox (as well as with the more recently introduced neuromodulators, such as Dysport and Xeomin) are referred to as "operator dependent." This simply means that the doctor administering the treatment has a lot to do with determining the ultimate outcome. In general, Botox works well for treating many kinds of wrinkling, including the "Eleven Lines" (Frown Lines, Scowl Lines, Angry Lines) and the horizontal forehead "Worry Lines." Freezing the forehead to squelch all expression line muscular movement that contributed to the wrinkles was considered de riguer in the old days. However, for the longest time now, the goal of therapy is to reduce (not eliminate) the activity of the muscles of facial expression that have become somewhat overactive with time or function that way as a natural tendency for some, even very young people.In the over 22 years I have been injecting Botox for cosmetic reasons I have found the results of treatment with this agent to be gratifying and reproducible, meaning that the aesthetic benefits obtained are pretty much the same following each treatment session. The quizzical "Mephisto" look is an undesirable result of treatment, which fortunately can be treated during a touch up session, but should be avoided, if possible, in the first place. Although many injectors ask patients to return for touch-ups in two weeks, I prefer to have patients wait four weeks to diminish the chance of antibodies developing to the Botox, which can reduce the effectiveness of future treatments. Fillers make an excellent addendum treatment for further diminishing the fine, superficial static (at rest) wrinkles that form after years of folding the skin while emoting. I often do the combination at the same treatment, especially in younger patients. Studies have corroborated my own personal experience that combining Botox with fillers yields longer-lasting results, as well.

Donald B. Yoo, MD, FACS · Answer

The injection technique can be altered to avoid this effect.  By injecting lower on the forehead toward the temporal fusion line the arch of your eyebrows will not be as dramatic.  Also, injecting the muscles that depress the brow toward your inner eyebrows will help to elevate the brows in this area.

Jo Herzog, MD · Answer

Bouboukaki,  I think that you can get some improvement with a couple of little touch ups of your Botox. I have patients that tend to get highly arched brows as well as patients who want their brows raised. We alter their treatment as desired but until after the first time we don't know what the fine tuning will consist of so they have to come back for a touch up. Some doctors have everyone come for a check and do touch ups as needed but I prefer to have my patients come back in two weeks only if they notice a need.

Stephen M. Chen, MD · Answer

Thanks for sending in your pictures it really helps to illustrate your question.  Botox is a trial and error process.  Experienced providers can modify the injection techniques and volumes of botox to shape the brows.  I agree with the other doctors who mentioned that your result is from a V shaped injection technique.  Please go see a physician who will listen to your concerns and formulate a plan for you to achieve your desired results.

How to avoid mephisto lines when treating forehead wrinkles with Botox? Would a filler be a better solution? (photo)

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