Botox for Brow Ptosis?

I'm thinking of getting botox for my brow ptosis as I'm starting to get horizontal lines in my forehead and almost daily headaches to the front of my head from keeping my eyebrows lifted (otherwise the droop bothers me and feels heavy on my eyes). I've been trying to do some research as to whether this is a good alternate to surgery since it's not all that bad yet and am finding conflicting answers. My main concern is that the botox will make it worse. Can anyone help clear this up?

Doctor Answers 23

Botox Brow Lift - Beverly Hills

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Hello and thank you for the question.

Botox Cosmetic can be strategically injected into the upper facial region to both shape the brow and create a chemical brow lift. The lateral aspect of the brow can be raised up to a few millimeters and the results generally last 3 to 5 months, on average.  

In your specific case, you have an overall attractive brow shape and thus I would focus on raising your lateral brow. This may or may not alleviate your "heavy brow" symptoms, but it is certainly worth trying prior to considering an invasive surgical procedure.

Kindest Regards,

Glenn Vallecillos, M.D., F.A.C.S.

Beverly Hills Plastic Surgeon
4.9 out of 5 stars 30 reviews

Botox for brow ptosis

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I would suggest you seek out at least two professional opinions before deciding on Botox treatment for brow pstosis. Brow pstosis refers to a drooping brow, it is in fact possible to create a modest lifting of the eyebrow with Botox. However, not as a primary goal, it may be the welcomed result of treatment for crow's feet or vertical lines between the brows. In any case, I'd be very careful treating horizontal forehead lines in this case, as often this treatment can cause brow pstosis rather than correcting it.

Peter L. Kopelson, MD
Beverly Hills Dermatologic Surgeon

Botox is wonderful for wrinkles, but as you suspect may well reveal other underlying problems

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The "brow lift" with Botox is used to elevate the lateral brow slightly.  Injection may well make your ptosis of the brow or even excessive upper eyelid skin look worse.  Looking at the picture attached to your question, it appears as though your lateral brow is nicely positioned above the lateral orbital rim. The medial brow is at the margin of the orbital rim.  This alignment is very aesthetic and is actually the ideal.  

There are several issues in your question.  The 1st is the head aches.  These are wonderfully & usually immediately halted with the use of the Botox/Dysport injection.  This will effectively smooth the forehead & wrinkles between the brows above and on the nose.  The injection of these paralytics is effective when infiltrating under the lateral brow to induce some lift of the lateral brow, as well.  

Your picture shows a beautiful arch and adequate lateral elevation of the lateral brow.  The Dysport/Botox will not raise the medial brow, and injection into this area will undoubtably result in more ptosis.  The heaviness of the eyes and the need to actively raise the brows is most likely related to the very short orbit which leaves little space for the excess upper eyelid skin that develops with aging.  

It would be great to see you in person to be sure, but it sounds like the shallow orbit is making the excessive upper eyelid skin which feels very heavy on the eye and thus you lift your brows to "see' better. If this is the case, my recommendations would be to consider the upper eyelid blepharoplasty to remove the excess skin.  This results in a barely visible scar, alleviates the weight of the eyelid and reduces the need to elevate the brow subconsciously and volitionally.

I recommend Dysport/Botox to the forehead & between the brows medially & between to alleviate the tension, relieve you of the headaches, and to eliminate the wrinkles.  I would caution you away from considering a surgical brow lift as they often create an unusual brow shape and your brows are very aesthetic and well balanced.

Good luck!

Kimberley Lloyd O'Sullivan, MD
Providence Plastic Surgeon

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Botox brow lifting

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Thank you for your question. Shaping the brows is one my favorite parts of using Botox. It requires a very detailed understanding of the underlying anatomy as well as assessing each individual while they are animating their brows. By carefully placing Botox in the muscles that depress the brow, you can cause the brow to rest and relax in a lifted position. There are limits to how much you can lift, and for some surgery is better option. Incorrect assessment or placement can also lead to the reverse effect, so overall technique is critical. You can also shape the brow different. For example, you can raise the tail of the brow vs creating a raised arched brow vs creating a raised horizontal brow. It depends on the individual's desired brow aesthetic goals. I would consider this a very advanced technique so I would query your injector on their experience in this area.
As far as how many units may be needed, this also depends on which part of the brow you want to correct. For the inner brows, you may consider ~20 units (same as the frown line treatment). For the middle or outer brow, I generally use up to 5 units on each side.
You may also want to consider adding fillers to shape and raise the brow. Combining the two products can work synergistically together.

Botox brow lift

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Botox placement in the glabella can minimize the "11" or vertical lines that many people have.  It does this by relaxing the muscles.  There are three groups of muscles in this area that allows the eyebrows to move together and this makes those wrinkles.  Those muscles are also called depressor muscles as they pull down on the facial muscles. When they are relaxed they no longer pull down on the forehead and the antagonistic forehead muscle can lift the eyebrows in an unopposed fashion.

Ronald Shelton, MD
Manhattan Dermatologic Surgeon
4.9 out of 5 stars 39 reviews

Botox for brow ptosis? Answer: Botox Brow Lift!

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I can understand why the "brow lift/brow ptosis" thing is confusing with Botox (and Dysport). This is why it is SO important to see only a well-trained board-certified dermatologist or plastic surgeon when considering Botox. What seems so simple that some people think they can get it done in the mall, is really a complex art.

For headaches and lines in the forehead due to constant lifting of your eyebrows because they feel heavy, there is a GREAT solution with Botox. The "Botox brow lift" AVOIDS injecting your frontalis (forehead) muscle, because injecting and weakening that muscle will only increase your brow droop. The Botox brow lift includes injections only into the glabella, lateral brow area, and lateral orbicularis oculi (crow's feet area), to weaken the muscles under the brows that tend to pull them downward.

This will give you a naturally more open feeling, and less of a need to lift your brows yourself. It may even reduce some of your tension headache, though that is anecdotal and not to be relied on from an online answer forum!

I'd be happy to show you how this treatment works if you like, since it is one of my favorite things to do with Botox.

Jessica J. Krant, MD, MPH
New York Dermatologic Surgeon
4.7 out of 5 stars 41 reviews

Botox Cosmetic May Help Lift the Eyebrows

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Hi julepandme,

Botox Cosmetic is one medication that has been used for a collection of potential aesthetic treatments. Botox Cosmetic may be applied in specific ways to achieve certain results for facial rejuvenation. Reducing wrinkles is the most common application, but lifting the eyebrows or slimming the jawline are alternative treatments that have been used by plastic surgeons and dermatologists.

Botox Cosmetic has been used to raise the eyebrows. This non-surgical brow lift is achieved by injecting the muscles just below the eyebrow (orbicularis muscle) which pulls down the brow. Results are temporary and subtle. This non-surgical brow lift may not be noticeable if you have severely droopy eyebrows. Cosmetic surgery with an endoscopic brow lift would be more appropriate for severe eyebrow ptosis. Only after a comprehensive evaluation can a cosmetic physician help determine appropriate options for you. Best of luck.

Dr. Chaboki

Houtan Chaboki, MD
Washington DC Facial Plastic Surgeon
4.9 out of 5 stars 89 reviews

How Botox Allows Your Brows to Lift

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You are not alone in wondering about the benefits of Botox in lifting the brow. The important point to remember about Botox is that is a muscle relaxant. It doesn't pull or lift anything. The brow position is a tug of war between the muscles below and the muscles above the brow. If the muscles below are weakened with Botox the muscles above will have a greater effect and they will pull the brow upward. This is a subtle effect but in someone young like yourself this is probably all you need. If this doesn't achieve the degree of elevation that you wish then brow lifting surgery may be an option for you. See a plastic surgeon and have a consult for both

Thomas Buonassisi, MD
Vancouver Facial Plastic Surgeon
4.9 out of 5 stars 114 reviews

Botox and Brow ptosis

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With brow ptosis, Botox can be used to cheat a bit along the lateral brow.  But if your brow is really low, a brow lift should be considered.  This can often be done endoscopically with limited incisions and short recovery time.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Botox for Brow Ptosis

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Botox is a reasonable treatment for horizontal forehead creases. You can also get a limited brow lift. However, remember that the improvement is temporary, lasting 3-4 months. You say "it is not that bad yet", so Botox may be more appropriate at this time; surgery will  provide a more dramatic permanent result when necessary.

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 43 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.