Botox: Eyebrow Drooping Versus Eyebrow Arch Raising?

Question

Can you advise what resolves faster: Botox injections that make the eyebrow raise into a high evil-like arch, or Botox injections that make the eyebrow droop to a sleepy-like eyelid? Or do they both resolve in about the same amount of time? My cousin loves Botox but has experienced both problems in the many years she’s used Botox and claims eyebrow/eyelid drooping heals just a little faster. Is this true?

Robert Kearney, MD, FACS · Answer

The toxin breaks down at the same rate regardless of where it is placed.  Your cousin might be more sensitive to return of movement in one area over another but they should be the same.

Mark K. Markarian, MD, MSPH, FACS · Answer

Short answer: between high-arched eyebrows, an eyebrow droop, and a droopy ("sleepy") upper eyelid, the upper eyelid is likely the most unpredictable and may last the longest...The following is a discussion of the 3 different complications you expressed concern about...(1) A drooping eye-BROW may happen in the following scenarios:-- When the brow-elevating muscle in the forehead, the Frontalis, receives too high a dose of Botox.-- The Botox is sub-optimally placed too low in the forehead -- it should typically be placed at least 1 cm above the Brow. -- Over-injection of the glabella area (between the brows). -- It may also happen if you have a low set eyebrow to begin with, in which case any Botox to the Frontalis increases the likelihood of a brow droop. Ironically, a droopy eye-BROW from Botox can sometimes be improved with MORE Botox -- this time, the Botox is typically injected into the outside (top of the crow's feet) part of the eye (aka the lateral aspect of the orbicularis oculi muscle) to generate a bit of a brow lift in that area -- by injecting more Botox and paralyzing the orbicularis muscle that normally acts to depress the brow in that area, you may get a slight compensatory brow lift...If the extra Botox does not improve the brow droop, it will likely last as long as the full duration of the Botox -- 3-4 months.(2) High-arched eyebrows -- typically this happens when the outer part of your Frontalis (the brow-elevating muscle), is not adequately treated with Botox.  This can be remedied with a Botox "touch-up" in that area to improve the symmetry. (3) A droopy UPPER eyelid may occur if the Botox is injected too close to your eyelid-elevating muscle, the levator palpebra superioris. In such a scenario, the Botox will diffuse inadvertently onto the levator muscle and cause an eyelid droop.  A lower Botox dose typically diffuses onto the levator muscle and so the good news is that the eyelid droop will typically NOT last as long as the full Botox duration of 3-4 months, and may in fact resolve in less than a month. Note however, if the eyelid droop occurs shortly after injection (i.e. within 3-4 days), then your eyelid levator muscle likely received a significant dose of Botox and your eyelid droop may not resolve for 1-2 months...On a side note, you may have an increased risk of eye-LID drooping if you have a weakened upper eyelid muscle for neurological reasons, or a deeply set eye-BROW that would be more prone to drooping and result in skin gathering over the eyelid making the eyelid appear like it was drooping. A droopy upper eye-LID due to Botox can be treated with Apraclonidine eye-drops which can provide a small (2mm) improvement -- Apraclonidine 0.5, 1-2 drops, 3 times per day. Make sure you put in one drop at a time, tilt your head back, and close your eyes to make sure none of the eye-drop leaks out. Be sure your prescribing physician discusses all the potential side-effects of the drops, such as "adrenaline-like" symptoms like anxiety or heart pounding; you may also experience eye irritation, eye dryness, and eye pain, amongst other symptoms. If these symptoms occur, you will likely need to take some lubricating eye drops, lower the dose, switch the eye-drops, or stop the drops altogether...When it comes to Botox, I would recommend seeking the services of an experienced physician injector. I think the key with Botox lies in truly understanding the anatomy of the injected area, and more importantly the variability in the anatomy between patients -- for brows, the forehead, and anywhere else you plan on receiving a Botox injection. This includes having a firm understanding of the origin, insertion, and action of each muscle that will be injected, the thickness of each muscle targeted, how deep beneath the skin the actual muscle resides, and the patient variability therein. As an aesthetic-trained plastic surgeon, I am intrinsically biased since I operate in the area for browlifts and facelifts, and have a unique perspective to the muscle anatomy since I commonly dissect under the skin, see the actual muscles themselves, and learn "first-hand" the incredible variability between patients -- live, "on the OR table" -- as opposed to via lectures or a cadaver dissection. For me, this helps guide where to inject and where not to. However, with that said, I know many non-aesthetic trained plastic surgeons and other physicians who know the anatomy well despite not operating in that area, and get good results.Good luck.Dr Markarian

Ron Shelton, MD · Answer

I haven't studied which is faster to resolve, the outer eyebrow elevation unwanted side effect or the forehead/eyebrow droop after Botox. It is easier to correct the outer eyebrow arch elevation by placing one or two units in the unopposed frontalis forehead muscle which is elevating the eyebrow than it is to try to lift the eyebrow or forehead enough, with Botox, to make the patient feel more satisfied.

Kenneth D. Steinsapir, MD · Answer

Sometimes you get what you pay for.  I encourage you to look into my microdroplet botox, which is a patented botulinum toxin method for softening and lifting the eyebrows without the frozen forehead or recruitment lines.

Martie Gidon, MD, FRCPC, FAAD · Answer

It is difficult to predict which effect will wear off sooner.  I treat the forehead very conservatively to prevent the eybrows from drooping but if it did occur, it would only last a matter of weeks.  More units are injected into the frown which could cause the Spock brow so it could last longer, but it is so simple to adjust by placing a tiny amount of Botox above the area that the Spock brow shouldn't last any time at all.  Your cousin should be treated by a board certified dermatologist or plastic surgeon to try and prevent any disappointment.

Botox: Eyebrow Drooping Versus Eyebrow Arch Raising?

Answers (9)

Answer: Your cousin needs to find a better BOTOX service.

Answer: Your cousin needs to find a better BOTOX service.

Answer: Botox for an arched eyebrow

Answer: Botox for an arched eyebrow

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Botox: Eyebrow Drooping Versus Eyebrow Arch Raising?

Answers (9)

Answer: Your cousin needs to find a better BOTOX service.

Answer: Your cousin needs to find a better BOTOX service.

Answer: Botox for an arched eyebrow

Answer: Botox for an arched eyebrow

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Recommended reading

Everything you need to know about Botox

Our mission is to create a world where every investment in modern beauty is Worth It.