Botox Caused One Brow to Raise Higher Than the Other. What Can I Do?(photo)

Question

Botox Cased One Eye Brow to Raise Higher Than the Other.Can the Lower One Be Raised to Meet It

Young R. Cho, MD, PhD · Answer

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.  If on exam, you still have strong or visible brow depressor activity, then this can be a target for Botox and hence you can also raise the lower brow.

Ron Shelton, MD · Answer

This has not been an unusual question posed on this website. If the middle forehead is treated with Botox, the outer forehead sometimes overcompensates and tries to pull up the eyebrows because the middle/glabella can't any longer. Usually this is improved by placing just a couple of units in the correct location to minimize the pulling of the outer eyebrow. Care is taken so as not to inject the botox too low near the eyebrow.

Richard H. Tholen, MD, FACS · Answer

Botox paralyzes muscles and does not strengthen them, so what actually happened is too much Botox in the forehead above the brow that does NOT raise, or perhaps too much Botox in the muscles below the high brow (perhaps to reduce crows feet).

	A little Botox in the forehead above the high brow will relax the frontalis muscle that is pulling the brow upwards, and will let it drop. As others have stated, this will eliminate the ability for you to selectively raise your eyebrows in surprise or with normal facial animation, giving you a "frozen forehead" look. The solution NEXT TIME will be less Botox on the other side so both brows can move equally, or at least the same amount on each side, depending on which muscles you wish inactivated! Best wishes!

Jason E. Leedy, MD · Answer

When the eyebrows are asymmetric after Botox, correction is possible by weakening the muscles above the higher eyebrow. Often this just takes 1-2 units. There is no way to lift the lower eyebrow with Botox. If the lower side is too low the only thing to do is to wait for the Botox to wear off and make sure your doctor injects higher on the forehead next time.

Sue Ellen Cox, MD · Answer

It may be possible to raise the lower brow by injecting at the lateral aspect of the eyebrow. If that has already been done and it has not raised enough then the solution may be to lower the more elevated brow to achieve symmetry.

Kenneth D. Steinsapir, MD · Answer

Unfortunately this can cause recruitment of muscle activity for the untreated portion of the frontal is muscle at the edge of the forehead. This is often asymmetric. It is possible to have your forehead further paralyzed to reduce the brow hike but this also completes the frozen look for the forehead. I recommend trying a different injector for your next service. Also take a look a my patent method called microdroplet botulinum toxin discussed on my website (lidlift dot com).

Robert Strimling, MD · Answer

This can happen and is easy to fix with a little more Botox injected into the area above the brow that is slightly elevated.

Grant Stevens, MD · Answer

Greetings~

	If your primary goal is symmetry, it is very easy to inject a small amount of Botox over the brow that is too high or arched and make it look more similar to the other brow.  You may be able to get a bit more elevation on the lower side but your chances for a more even result are better if you are okay with bringing the higher brow down. Follow up with the office that injected you and they should be able to advise you on your options or best course of action. 

	Good luck~

	Dr. Grant Stevens

Niketa Sonavane, MD, MBBS · Answer

Assymetry of eyebrows is probably one of the most common complaints that is addressed in the post procedure follow up. Correction usually requires just 1-2 units of Botox placed above the raised eyebrow to lower it. Sometimes 2-3 units of Botox can be placed just below the lower eyebrow to give a unilateral brow lift to raise it slightly. Asymmetric brow activity occurs due to inadvertent over treatment or low injection on the side of the lower brow or an asymmetric frontalis activity which was missed in the initial assessment or recruitment of untreated muscle fibers on the side of the raised brow.

	Keep looking beautiful.

Alexandra Chambers, MD, PhD · Answer

Thanks for your question.

	As you probably know, Botulinum toxin A works by selectively relaxing muscles, and thus, muscles that have not been targeted will continue to be active.  From your photo, it looks like the left lateral forehead muscle is more active than the right, and the solution is simple... inject a bit more botox, say 1 unit, in this area.

Botox Caused One Brow to Raise Higher Than the Other. What Can I Do?(photo)

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