Too Often Botox Injection Cause Permanent Eyebrows to Droop?

I got Botox for 3 times. The second one was March 20th, but unfortunately the third one was just June 18th. This means it's been only 3 months between 2 Botox injections. I think this is the reason why I got eyebrows droop this time. Does this mean I already got muscle atrophy? Is it permanent? Should I do some facial exercise or something else to help this? Thank you so much.

Doctor Answers 10

Too Often Botox Injection Cause Permanent Eyebrows to Droop?

 I havbe used neurotoxins like Botox, Dysport and Xeomin for 25 years and their effects, good or bad, are temporary and not permanent.  

Beverly Hills Facial Plastic Surgeon
4.6 out of 5 stars 25 reviews

You brow drops because this is precisely what most treatments with botox to the forehead cause.

The frontalis muscle of the forehead does produce forehead lines.  Doctors very commonly blast this muscle with BOTOX in a misguided attempt to reduce the forehead lines.  The reality is that it is possible with enough BOTOX to completely paralyze this muscle and basically eliminate all forehead lines.  Unfortunately, this all too common treatment outcome is aesthetically all wrong.  It causes a glass smooth forehead, yes, but also a frozen forehead and a fallen eyebrow ( Think Marcia Cross in Desperate House Wives.)  Doctors think this is a great treatment result because they do not know better.  However this is precisely the look that is lampooned by the media and feared by the public.  I figured out that there is an alternative to this type of treatment result.  We get forehead lines because you have two groups of muscles that work against each other at the eyebrow.  The frontalis in the forehead lifts the brow.  Muscle just underneath the eyebrow ( orbital orbicularis oculi muscle)  pull the brow down.  They meet just beneath the skin of the eyebrow where they interdigitate.  These opposing muscle groups produce ridging which is used to furrow the brow and menace people and show dissatisfaction.  The brow pinch also makes you look angry.  Doctors avoid treating the muscles at the brow for fear of causing an upper eyelid ptosis with BOTOX.  The consensus treatment pattern specifically avoids the orbital rim for this reason.  However, I observed that there is a way to trap small volumes of BOTOX just beneath the eyebrow skin where these muscles insert to make the expressions along the eyebrow.  The microdroplets are effectively trapped between the skin and the muscles, directly treating the muscle.  The injected solution can't diffuse into the eyelid, so no droopy eyelid.  This direct treatment selectively weakens the eyebrow depressors without effecting the bulk of the frontalis muscle in the forehead.  Now most of the forehead wrinkles are the result of the frontalis working against the eyebrow depressors.  By reducing this work, the lines in the forehead improve without paralyzing the frontalis muscle.  The brow goes up and the forehead lines reduce.  This means that normal forehead movement is preserved, so no BOTOX freeze. This method is called Microdroplet BOTOX.  It also works with Xeomin and Dysport.  The method is so unique that it was granted a United States patent.  


Your current treatment will wear off with or without exercise.  After that you might consider looking into my method.

Kenneth D. Steinsapir, MD
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

Neurotoxins Should Be Used Judiciously When Treating Forehead Lines In Patients With Brow Ptosis

Your eyebrow droop is not permanent and will improve over several months as the Botox breaks down. Facial exercises will not offer any improvement.

Your eyebrow droop (ptosis) is most likely related to over-treating the forehead (frontalis) muscles. An experienced and conscientious injector should evaluate the appearance of your static forehead lines (at rest), your dynamic forehead lines (when you raise your eyebrows), the amount of brow ptosis present, and the eyebrow position at rest and with contraction. The dose of neurotoxin used, and the placement of the injections, is based upon everything listed above. The forehead is commonly over treated by many physicians because they fail to consider the degree of brow ptosis.

Patients with brow ptosis may have deeper forehead lines because they unconsciously raise their eyebrows to reduce the otherwise heavy feeling/sensation that occurs from the excess skin falling onto their upper eyelids. The answer is not more neurotoxin. The answer is a thorough explanation of brow ptosis and what has happened as a result. It is important that they understand that their forehead lines will not be eliminated with a neurotoxin treatment. If their ptosis is moderate or greater, a brow lift may be a nice option for them.

Best wishes, Ken Dembny

Kenneth Dembny, II, MD
Milwaukee Plastic Surgeon
4.9 out of 5 stars 34 reviews

Efffect of Botox

The best and worst thing about botulinum toxins, such as Botox, are that they are all temporary.  You do not need to exercise as full muscle function will return 2-6 months after injection.

Mehryar (Ray) Taban, MD, FACS
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 73 reviews

Botox effects are temporary

This is probably not permanent and will go away as the BOTOX effect goes away. I don't suggest doing facial exercises. Muscle atrophy does not generally occur so quickly.

Jerome Edelstein, MD
Toronto Plastic Surgeon
5.0 out of 5 stars 179 reviews

Botox performed too frequently...

You likely had some overlap of Botox effects with your last 2 treatments and this caused the brow droop... but rest-assured, the Botox effect is temporary and reversible with time.  It is highly UN-likely that you have muscle atrophy. 

Good news is that your brow position will improve with time.  Facial exercises, massaging, or other similar activities will not help; only time will.

I would encourage you to seek the services of an experienced physician injector. I think the key 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, 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 and see the actual muscles themselves. For me, this helps guide where to inject and where not to. However, with that said, I know many Dermatologists who know the anatomy well despite not operating in that area, and get great results.

Good luck.

Botox does not cause permanent muscle atrophy

Having botox three months after the last treatment is more the norm than the exception. It does not cause a permanent problem. The muscles "wake up" and do not clinically atrophy after the botox is discontinued.

Ronald Shelton, MD
Manhattan Dermatologic Surgeon
4.9 out of 5 stars 38 reviews

Botox and eyebrow droop

You do not have muscle atrophy.  The effect of your Botox will wear off.  You should probably space your injections further apart. It is possible that you may require less Botox than previously injected.

Martie Gidon, MD, FRCPC
Toronto Dermatologist
5.0 out of 5 stars 22 reviews

Droopy Eyebrows are not permanent with Botox

While Botox can cause severe problems if misused in children with cerebral palsy it cannot cause any permanent  problems when used at the doses which are used to treat the frown.


Arnold W. Klein, MD (in memoriam)
Beverly Hills Dermatologic Surgeon
4.8 out of 5 stars 5 reviews

There are no permanent effects on eyebrows with Botox

Three injections over such a short period of time will not produce atrophy. Atrophy of muscle groups takes months to years to observe and is a function of non-use. The effects of Botox are not permanent and the molecule as well of the effects dissipate with time.

Curt Samlaska, MD
Las Vegas Dermatologist
5.0 out of 5 stars 4 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.