Botox in Forehead Dropped my Eyebrows Instead of Lifting

Question

i have had botox twice in my forehead, both times with the same results; it drops my eyebrows so much that my eyelids droop and the whole look of my eyes is changed, and not for the best. i have prominent half moon shape lines above each eyebrow, and it would appear that these are what keep my eyes lifted, although i'm not sure if the wrinkles in my forehead are helping as well. my doc thinks i have rare opposing muscles in my forehead. do you know how botox should be administered?

Kenneth D. Steinsapir, MD · Answer

Where your eyebrows sit is a tug of war between the eyebrow lifter (frontalis muscle of the forehead) and the eyebrow depressors (primarily the depressor obicularis oculi muscle.)  It is true that the unwanted lines on the forehead are produced by the frontalis muscle.  Weaken this muscle and the lines improve but at the expense of eyebrow position.  This means the eyebrows will fall.  I developed the MicrodropletTM BOTOX method to create eyebrow lift.  By leaving the frontalis alone and focusing treatment in the obicularis oculi muscle of the eyelids, it is possible to directly weaken the muscles that are pulling down the eyebrows.  The eyebrows lift, and the forehead lines diminish because the frontalis muscle does not have to work as hard to counter act the pull of the eyebrows.

Sheldon Pollack, MD · Answer

Unfortunately, forehead drooping (ptosis) after Botox injections is not uncommon. This is one of the most difficult areas to treat properly.  The injector must consider the tightness of your brow, the pre-existing drooping of your upper face and which areas will droop further with injections.  In my Toronto clinic, we always feel the brow to see how readily it can be made to droop, by pulling downwards on the skin.  In most individuals, drooping will be accentuated when you gently push down the lateral sides of the brow. When the same is done in the middle part of the brow, less drooping is evident. Try this in front of a mirror and you will see what I mean.  In order to lift the brow, we must weaken the muscles that pull your brow down (the muscles that you use to tightly close your eyes) while allowing the muscles above your eyebrows to continue to pull upwards.  In some patients, I find that only small amounts of Botox should be used, usually in the mid portion of the brow, while in others, after testing and finding the skin to be very loose, Botox is definitely not recommended.  I hope that this helps.

	Sheldon Pollack, M.D., Toronto Cosmetic Skin Surgery Centre, Inc.

Jana K. Rasmussen, MD (retired) · Answer

As you know, BOTOX Cosmetic is a paralyzing agent. It is FDA approved for injection into the frown lines of the forehead, or glabella area. Injection into the forehead wrinkles (those across the forehead) is an off-label use of Botox that is well accepted.This muscle, the frontalis, acts to raise the forehead and eyebrows, so when Botox is injected in any of the wrinkles across the forehead, this muscle will relax, i.e., it will no longer lift the brows.  There is an "unwritten rule" that to prevent drooping or lowering of the eyebrows, that the injector, hopefully a trained physician, will stay at least 1.5cm  (or about 3/4 inch) above the eyebrows.  This will allow some of the muscle to continue to function, thereby preventing drooping of the eyebrows.  Unfortunately, if one has wrinkles in this area, those wrinkles will not "go away". Usually my patients prefer the wrinkles just above the eyebrows over the dropped brow.  This should be discussed with any patient considering Botox in the forehead before injection to avoid a result that is less than satisfactory.

Botox in Forehead Dropped my Eyebrows Instead of Lifting

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Botox in Forehead Dropped my Eyebrows Instead of Lifting

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