Can this be fixed and can I ask for a refund? (Photos)

Question

I had botox injections previously by an RN with amazing results. I went to a dermatologist this time who was cheaper and did not think there would be repercussions. When she administered the botox it was actually quite painful unlike my previous experience. My eyebrows are now flat and not proportionate. When I try to lift them both evenly, I get the result in the 2nd picture. I would like to get a refund but I am not sure that is possible. 3rd photo is how eyebrows normally look.

John Bitner, MD · Answer

Obviously, you can see the asymmetry in your brows.  I honestly think that they may have underdosed the right brow, causing it to move and have the muscles unevenly lifting the brows.  Your pictures are somewhat limiting, but I would consider going back to be reevaluated.  I always try to be a patient advocate, especially when I have a patient who comes back with concerns.  I hope the dermatologist would do the same.  However, I do agree that cheapest is not always the best route to choose, especially when your are having something done to your face!!!!  These pictures do not demonstrate ptosis.

Yannis Alexandrides, MD, FACS · Answer

I'm sorry to hear about your experience. You may of had a bad experience this time, and it appears you are experiencing a level of ptosis. This doesn't and won't always happen so don't let this deter you.  The establishment and price will also be an indicator of the quality and efficacy of the treatment. We advocate visiting a reputable clinic and have the Botox administered by an aesthetic nurse or plastic surgeon if you haven't already done so.  Dropping can occur for a number of reasons: Sometimes Botox injections can be placed too low, or too much of the substance has been placed in your forehead (this can happen if you have a small forehead) or the product has migrated to the levator muscles - you should rest assured that the effects will subside within 3-6 months and won't be permanent.

Eric M. Joseph, MD · Answer

At this point, consider getting your right brow frozen with BTX, so it is symmetrical with your left and less distracting when you elevate your brows. You may also benefit from BTX to the tails of your eyebrows on both sides for a slight lift. Definitely don't worry about this because BTX always wears off, and in the meantime, improvement may be possible with an artful dose adjustment. Hope this helps! Dr Joseph

Daniel Barrett, MD · Answer

Dear kbellxo21,Botox is generally an on off switch for muscle activity. I get a fair amount of actors/actresses in my practice that are looking to reduce wrinkles but keep some expression. Most of patients see first changes after 4-7 days and the final results after 10-14 days. Finding an experienced physician injector is your best bet. Regarding the refund, it would be the best to check it with your injector.Daniel Barrett, MD, MHA, MS 
Certified, American Board of Plastic Surgery  
Member, Am. Society of Plastic Surgery

Lee B. Daniel, MD · Answer

So sorry to hear you’ve had a bad experience with BOTOX®. It does appear that the injections were placed too close to your eyebrows, which is causing the sagging effect you’re seeing. Unfortunately, it’s unlikely that you’ll get a full refund for your injections, but it may be worth contacting your dermatologist and at least letting them know you’re unhappy with your results. As for fixing the problem, you do have to be careful about adding more BOTOX® to the area, as you don’t want to worsen the problem. I would suggest making an appointment with your previous injector or another board-certified plastic surgeon to see if there’s anything they may be able to do to help. Otherwise, you may have to wait for the BOTOX® to dissolve.

Wayne Wertheim, MD · Answer

It appears that the injector did not inject with respect to your anatomy. I would discuss your concerns with the physician. Dont expect a refund. If you were happy and trusting of your previous injector you should go back. I hope you have learned that you dont choose an injector based on price. Someone that is an expert injector and has a great reputation is probably worth a bit more than an unknown entity. The best thing is that botox is not permanent and all will go back to normal ... in time.
Good luck

Shaun Patel, MD · Answer

Sorry to hear about your experience. It appears that the Botox was injected incorrectly, too close to the eyebrows and without consideration for a normal female eyebrow shape. I would discuss your results with your injector to see if anything can be done. A small amount of Botox may be injected at the tail of the eyebrows to give them some raise. Otherwise, I suspect you will need to wait for the Botox to wear off.

Michael Tomcik, MD · Answer

Thank you for your question. 
At this point, it appears that you may benefit from some minimal injections in your right brow and you may benefit from some minimal botox units near the tail of both brows, a technique called "brow lift".   An experts injector may be able to help you with this. A good injector has an understanding of facial anatomy and takes precautions to avoid heavy brow (brow ptosis). In our clinic, we take all the precautions by collecting a thorough patient history, using meticulous technique, and lastly educate our patients on post care,  such as avoiding massaging the treatment areas. Hope this helps. 
Best, Dr. Tomcik

Melvin Elson, MD · Answer

The injections were probably too low and this caused the issue. the fact that it was painful is an indication that the injector was inexperienced or that the Botox was not mixed right.  Not all dermatologists are experienced in cosmetic procedures and you should be careful about getting things done because they are cheap.. You will not be able to get a refund

Inessa Fishman, MD · Answer

I suggest you discuss your concerns with your Dermatologist.  Botox generally takes a few days to start working, and shows 100% of its results closer to 2 weeks after injection.  Depending on your exam, a few key injections of additional Botox can help even out the brows.  The refund question is managed differently by individual practices.  You can always seek another opinion from another injector.

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