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

Question

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?

Ron Shelton, MD · Answer

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.

Young R. Cho, MD, PhD · Answer

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.

Harold J. Kaplan, MD · Answer

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.

Kenneth D. Steinsapir, MD · Answer

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.

William Groff, DO · Answer

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.

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

Answers (10)

Answer: Too much botox in the forehead

Answer: Too much botox in the forehead

Answer: Botox complications

Answer: Botox complications

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Everything you need to know about Botox

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

Answers (10)

Answer: Too much botox in the forehead

Answer: Too much botox in the forehead

Answer: Botox complications

Answer: Botox complications

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Recommended reading

Everything you need to know about Botox

Our mission is to create a world where every investment in modern beauty is Worth It.