Botox Gave Me Angry Brows, Can this be Adjusted?

Question

I recently had Botox on my forehead, and asked for the ends of my brows to be slightly lifted so as to raise my sagging upper eyelids. It did do that, but now I have angry "Spock" brows. I'm going back for my follow-up. Can the rest of my brow (front and center) also be raised at this point so they're straighter across?

Sanusi Umar, MD · Answer

Indeed, Botox can be used to adjust the outcome that you described. However this really depends on the implementation of proper technique. Additional injections in the lateral area should relax the muscles that are tugging the outer ends of your brows and making them higher than you would like them to be. If you choose to have this result corrected, the initial dosage should be conservative. Higher amounts can then be administered incrementally.Your other option, of course, is to let the Botox wear off.

Ron Shelton, MD · Answer

Unfortunately the Spock eyebrow isn't fixed by raising the middle because an attempt at placing Botox at the mid eyebrow in its plane to lessen the lowering effect would risk the Botox spreading below the area and affect the levator muscle of the upper eyelid thereby weakening it and causing an eyelid droop. This can last for more than three months. The Spock eyebrow is adjusted by lowering the outer forehead that is elevated and is elevated by an unopposed contraction of the outer frontalis muscle which is compensating for the middle frontalis that can't move.

Michael A. Epstein, MD, FACS · Answer

The quick answer is that the "Spock" appearance that you have as a result of your Botox injections can be easily rectified by having additional injections placed more laterally ( further to the sides ) over each eyebrow. This will weaken that portion of the frontalis muscle which is aggressively elevating the outside of your brow. It may be possible to create more elevation of the inside of your eyebrows but this may be a more difficult task after your original injections have been completed. Your doctor or nurse injector should take special note of this particular outcome so that the next time you have Botox injections, they will be more aware of how you respond, and be better equipped to avoid this problem in the future.

Barry Resnik, MD · Answer

When this occurs in my patients, I simply place a drop of BOTOX at the top of the "angry brow" to lower it a bit. It is not a worry. However, you can't move the medial portion up, as it is relaxed with BOTOX.

Michael M. Kim, MD · Answer

The "chemical browlift" is very popular with patients, but in some cases, the lateral brow can be lifted too much. Imagine that the lateral brow is in the middle of a tug-of-war between the brow depressors (pull down the brow; part of the muscle that goes around the eye), and the brow elevators (pull up on the brow; lateral portion of the frontalis muscle). When you use a neuromodulator like botox on the brow depressor, it weakens that team and essentially lets go of the rope. This allows the brow elevators to "win" and bring the brow up. This effect is variable in different patients.

	In your case, the brow elevators are likely quite strong. It is possible to achieve a balance by having additional, small doses to weaken the brow elevators. I would ask your board-certified (hopefully) injector about this issue.

	 

	As for raising the medial brow, there are no non-surgical ways to do this. In addition, it is unlikely that you would want to do this anyways, since you would go from an "angry, spock" look to one of "surprise." I hope that helps and good luck.

	Michael Kim, MD

Botox Gave Me Angry Brows, Can this be Adjusted?

Answers (7)