Which Botox Placement, or Combination Of, Results in Flat Eyebrows?

I have had upper forehead, crows feet, and 11's treated for a few years. Not always at the same time. Occasionally I get flat eyebrows that look a little heavy. What causes this? What adjustment do you recommend?

Doctor Answers 10

Botox and flat eyebrows

over time, women who have had their forehead and glabella treated may start to notice that the exact same forehead treatment starts to make their eyebrows flat and with that, their upper eyelids heavy. When younger, there is more tone to the forehead muscle and it can be used by your face without your knowing to start to help lift the eyebrow as it wants to sag (in the mid to late thirties). As your face starts doing this, you won't see the 'hooding" of the upper eyelid skin or flat eyebrow until the Botox relaxes the forehead muscle.  Sometimes you continue to have some but not as much of the forehead treated as you did when you were younger. You might only have the upper forehead done.  There are some women, espeically those starting in their fifties who can no longer have the forehead done, because their eyebrows and upper eyelids are too low and sagging. They would need a brow lift and / or blepharoplasty. If the outer tail of the eyebrow is not treated with your crow's feet then Botox can be added there and it may lift up the forehead a little. Also, the units used in your inner glabella might need to be increased if there is still some muscle activity after your botox, as these are strong depressors and more units might make them relax more and help lift the forehead.


Manhattan Dermatologic Surgeon
4.9 out of 5 stars 37 reviews

Which Botox Placement, or Combination Of, Results in Flat Eyebrows?

Injection of any of the neurotxins, Botox, Dysport or the new Xeomin can weaken the muscles responsible for eyebrow position.  This will cause the eyebrows to droop.  The rule of thumb is to remain two finger widths above the mid and lateral sections, of the eyebrows, when injecting the forehead wrinkles in order to avoid this issue.

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.6 out of 5 stars 24 reviews

Flat Brow after Botox.

Hi DC.  A flat brow after Botox is caused by improper placement of the product too close to the brow.

If your injector has done this to you multiple times over the years, it may be time to consider a new one.  A good injector can smooth the frown lines and forehead without a perceptible change to the brow.  You can certainly address this with your injector if you want to stick with that person or you can consider speaking to someone else.  

Regardless of degree, your injector needs to understand facial anatomy well to properly inject Botox.  In many situations like yours, the injector does not and has not been trained properly.

Harold J. Kaplan, MD
Los Angeles Facial Plastic Surgeon
4.5 out of 5 stars 8 reviews

Botox and Dysport help treat wrinkles on the forehead, glabella, and eyes

however the forehead muscles are the only ones that raise the eyebrows, so if you feel they are too flat, your doctor should avoid treating all of your forehead, and perhaps try a very small dose that will still allow some movement.  Best to you

Carolyn Jacob, MD
Chicago Dermatologic Surgeon
5.0 out of 5 stars 5 reviews

Flat eyebrows

Flat eyebrows may look virile in a man but are not so attractive in a female.

To give a nice arch to the eyebrow, two injections should be placed lateral to the central glabellar injection point. This will give a nice arch to the eyebrow, which many injectors will supplement with another injection at the lateral brow,  the so-called "lateral brow lift". 

I agree with my colleagues, that your injector placed your Botox too low. Injections should be no lower than 2-3 cms. above the brow. In addition, you may have had too heavy a dose of Botox. If you note that you lack movement of your forehead, this is undoubetdly true and an additional cause for your flat eyebrows. It is always better to place fewer units in the forehead, with a touch up later if needed, than to overdose the forehead giving, at best a "deer in the headlights" look. 

One other adjustment, make sure the injector also places Botox in your "11"'s even if you only want your forehead treated. This in itself, will cause some forehead elevation,  obviating the need for more units in that region.

 

Arnold R. Oppenheim, MD
Virginia Beach Dermatologist
4.7 out of 5 stars 13 reviews

Flat eyebrows

As they say in the real estate industry-location, location, location. You need to have the Botox place a little higher. If necessary ask your doctor to use less as well and wait a week or two to see the result. You can easily add more if you need to to fine tune it.

Michael L. Schwartz, MD
West Palm Beach Facial Plastic Surgeon
4.7 out of 5 stars 9 reviews

Too much botox in the forehead

Unfortunately this type of result is all too common.  Doctors often rely on the lack of movement as their treatment goal.  This creates an unnatural and inauthentic appearance with a dropped and immobile eyebrow.  Treatment does not have to result in this type of effect.  A change of injector can be a reasonable choice.  Also study my microdroplet botulinum toxin method on my website to understand how alternative treatment works.

Kenneth D. Steinsapir, MD
Los Angeles Oculoplastic Surgeon
4.9 out of 5 stars 23 reviews

Botox complications

Flattened eyebrows after Botox treatment is either caused by injecting to low on the forehead or injecting too much Botox into the forehead.  I recommend going to a Dermatologist that has more experience than your current injector.

William Groff, DO
San Diego Dermatologist
4.8 out of 5 stars 39 reviews

Flat eyebrows from Botox injections

This has to do with the placement of the Botox. In the forehead is what's called the frontalis muscle. If Botox is injected too low into this, it will cause the center of the eyebrow to fall, making it look flat. Your injector needs to raise the placement of Botox in this area to avoid having this happen.

Botox brow lifting

Thank you for your question. Shaping the brows is one my favorite parts of using Botox. It requires a very detailed understanding of the underlying anatomy as well as assessing each individual while they are animating their brows. By carefully placing Botox in the muscles that depress the brow, you can cause the brow to rest and relax in a lifted position. There are limits to how much you can lift, and for some surgery is better option. Incorrect assessment or placement can also lead to the reverse effect, so overall technique is critical. You can also shape the brow different. For example, you can raise the tail of the brow vs creating a raised arched brow vs creating a raised horizontal brow. It depends on the individual's desired brow aesthetic goals. I would consider this a very advanced technique so I would query your injector on their experience in this area.
As far as how many units may be needed, this also depends on which part of the brow you want to correct. For the inner brows, you may consider ~20 units (same as the frown line treatment). For the middle or outer brow, I generally use up to 5 units on each side.
You may also want to consider adding fillers to shape and raise the brow. Combining the two products can work synergistically together.

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.