Will Botox Help Even out my Eyebrows and Eyes? (photo)

Question

I'm only 20 years old but my face is slightly uneven and it really bothers me. Do you think botox can help even out my face?

Mehryar (Ray) Taban, MD, FACS · Answer

Botox can help even out the asymmetric eyebrows by lowering the left side and raising the right side. The asymmetry is likely from underlying facial bony asymmetry with right side being smaller than the left.

Kevin M. Robertson, MD, FACS · Answer

You could improve your symmetry with small, discrete botox injections. We can put small amounts by your brows to help lift them, which is pretty straight forward. A more advanced application also uses small amounts closer to the eye, to alter the aperture or shape as well. This takes a certain amount of experience and comfort on the part of the injector, so make sure you see a physician for this, and one experienced in injections like this. There are a couple of good articles by Steve Fagien that describe what you are considering, so you might want to look for them for more information.

Kenneth D. Steinsapir, MD · Answer

The real question here is why do you have upper eyelid retraction?  In both photographs what we see is bilateral upper eyelid retraction.  The left seems slightly more retracted than the right.  There is also a left brow elevation.  Generally unilateral brow elevations are compensatory.  Here it is not clear why you would have a compensatory brow elevation.  Yes a skilled injector could soften the position of the left eyebrow with BOTOX. 

	A much more important question is why do you have upper eyelid retraction.  The eyes are so open you almost have superior scleral show.  The most common reason for this is an overactive thyroid gland generally from Grave's disease.  You may or may not actually have an overactive thyroid on testing.  There are forms of Grave's disease where the thyroid function tests are normal (euthyroid Grave's)  Clinical symptoms of an overactive thyroid include heat intolerance, palpitations or a racing heart, unexplained weight loss, loose stools, etc.  

	I recommend a consultation with an oculoplastic surgeon and thyroid function testing by your primary care physician.

Kurtis Martin, MD · Answer

Your asymmetry is very minimal but botox under your right lateral brow should elevate it enough to make a difference. It is worth a try since if you don't like it, it will slowly resolve in 3-4 months.

Leyda Elizabeth Bowes, MD · Answer

Botox is most commonly used to treat wrinkles caused by certain facial expressions (frown, forehead and crowsfeet areas). However, it Can be Used to Correct Specific Facial Asymmetries. The strategic placement of Botox in specific areas of the face and at specific doses, will help soften/relax certain muscles while others maintain their resting muscle tone and are also able to contract voluntarily. However, this requires special expertise and understanding of the anatomy of the face, in order to achieve the desired results.

Benjamin Van Raalte, MD · Answer

You will need to seek a physician with a lot of experience injecting Botox. It might also be trial and error with a little more added or less the next visit to get better symmetry.

	There is not an exact correlation with the dose of the Botox and the amount of relaxation of a muscle, and therefore lift from an unopposed muscle. Sometimes the unopposed muscle can create a crease that is noticeable when it pulls creating an arch that that either needs partial treatment or adjustment.

	Asymmetry due to uneven bony structure, eyelid folds, and some other differences cannot be helped of course. But raising one eyebrow can be done by a small dose just under the lateral eyebrow to relax the muscles that pull it down.

George T. Boris, MD, FRCS · Answer

Botox is a great agent for preventing/softening wrinkles but can also be used to make features more symmetrical. The key is using a skilled Dr. with experience. Best of luck!

Stephen Weber MD, FACS · Answer

A consultation would be required to give you the most accurate answer. However, Botox can often be used to improve subtle asymmetries. This could involve treatment on your right (left side of the photo) to raise the brow. If this is not enough improvement a small amount of Botox could be placed on the left to lower the eyebrow and further improve symmetry. I hope this information is helpful.

Hratch Karamanoukian, MD, FACS · Answer

I believe that Botox under the right eyebrow can give you symmetry by elevating the tail end of your eyebrow. OR, you can get unilateral Ultherapy for the right eyebrow - it is FDA approved for this indication.

Michael M. Kim, MD · Answer

Hello,

	I believe that neuromodulator treatments would potentially give you better symmetry. The symmetry would be possible by placing some of the product under the tail of your right brow. This allows for a modest lift to the lateral eyebrow (closest to your ear) and is called a "chemical browlift." The medial brow (closest to your nose) won't change position and will still be slightly asymmetric.

	I hope this helps.

	Michael Kim, MD

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