1 Week After Botox to Forehead and Frown Lines my Brows Have Started to Droop, Is this Likely to Get Worse?

Question

It is 6 days since i had botox on my forehead a nd between brows,under my brows appear swollen a bit and drooped a small bit,is this likely to get worse,also if botox sets in a few hours why can you get drooping brows weeks later.I stayed out the gym but want to go back tomorrow,but im afraid lifting weights and cardio will cause drooping,as i read in one report to avoid the gym for two weeks,also i use lots of force lifting weights,please advice thanks

Mark K. Markarian, MD, MSPH, FACS · Answer

Botox typically takes 7-10 days to reach full effect, so your brow may get a little worse before it improves... However, the good news is that this is NOT likely to be permanent and should improve.A drooping eye-BROW may happen in the following scenarios:(1) When the brow-elevating muscle in the forehead, the Frontalis, receives too high a dose of Botox.(2) The Botox is sub-optimally placed too low in the forehead -- it should typically be placed at least 1 cm above the Brow.  (3) Over-injection of the glabella area (between the brows).  (4) It may also happen if you have a low set eyebrow to begin with, in which case any Botox to the Frontalis increases the likelihood of a brow droop. Ironically, a droopy eyebrow from Botox can sometimes be improved with MORE Botox -- this time injected into the outside (top of the crow's feet) part of the eye (the lateral aspect of the orbicularis oculi muscle) to generate a bit of a brow lift in that area -- by injecting more Botox and paralyzing the orbicularis muscle that normally acts to depress the brow in that area, you may get a slight compensatory brow lift...In terms of exercise, there should be no problem with you working out now, 6 days out -- it will not "spread" the Botox or make anything worse.In terms of getting your Brow treated as discussed above, my recommendations are to seek the services of an experienced physician injector. I think the key with Botox 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, how deep beneath the skin the actual muscle resides, 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, see the actual muscles themselves, and learn "first-hand" the incredible variability between patients -- live, "on the OR table" -- as opposed to via lectures or a cadaver dissection. For me, this helps guide where to inject and where not to. However, with that said, I know many non-aesthetic trained plastic surgeons and other physicians who know the anatomy well despite not operating in that area, and get good results.Good luck.Dr Markarian

Ron Shelton, MD · Answer

Although the Botox starts to bind quickly and doctors allow patients to bend over after several hours, the muscle relaxation can take up to two weeks to see the maximum effect. If your forehead has sagged in the past and your forehead muscle is constantly trying to keep it up, then botox can relax its function to the point that your forehead will drop to where it was trying to go but for the effect of the forehead muscle. It may drop slighlty further in the next week. If you didn't have many units injected in the glabella or outer eyebrows, this might help lessen the depressor effect of those muscles and might give your forehead some lift.

Jeffrey Zwiren, MD · Answer

The corragator muscle is interwoven with the frontalis muscle. The corragator muscle creates the vertical glabellar creases and this muscle is a depressor of the inner aspect of the brow so this muscle will cause an elevation of the medial brow. If the injection is performed too high or if the Botox spreads superiorly then the frontalis muscle can be effected and this causes the brow to drop.

Martie Gidon, MD, FRCPC, FAAD · Answer

If too much Botox was injected into your forehead lines, it can cause a heavy sensation and lowering of the brows.  It can take up to 12 days to see this effect and it can last about 6 to 8 weeks before your brows will start to lift again.  Hopefully you are being treated by an experienced dermatologist or plastic surgeon.  Mention lowering of your brow at your next visit so the dosage can be adjusted.

	You can exercise 4 hours after receiving Botox injections.

Stacey Tull, MD · Answer

This is likely due to over treatment of the forehead lines. The good news is that you may still get some brow elevation to offset this at about 2 weeks post injection (or you can have it done if you did not get injections at the midpoint of your brows above the pupil). This comes from the relaxation of the frown muscles which takes about a week longer to set in than the initial blocking of contraction that you get within the first week of injection. If you choose to have your forehead lines treated in the future, I would recommend that they only inject in the top 1/2 of your forehead and maybe use a more conservative dose.

Francis R. Palmer, III, MD (retired) · Answer

Most likely, the results of the forehead Botox injections have already peaked at 6 days. Next time you may want to avoid having the neurotoxin (Botox, Dysport or Xeomin) placed within 2 finger widths of the eyebrows in order to prevent eyebrow droop. Understanding and following the proper aesthetics of facial beauty is important in all plastic and cosmetic surgery treatments and procedures, including Botox Injections.

F. Victor Rueckl, MD (in memoriam) · Answer

Overinjection into the glabella area, or injection too low above the eyebrows, can cause a droop in the eyebrows themselves. The fortunate thing about Botox is that it's not permanent, so this will resolve. But it will also take some time, probably a month or so to resolve. As your muscles start to work a bit again, it will allow the brow to raise back up. It doesn't matter if you lift weights or do anything strenuous, it won't make any difference.

	The onset of Botox starts in a few hours, but it can take up to 10 days for all the muscles to be fully affected by the neurotoxin - this is why you'll see some muscles change a few days after others, and if you will get a brow drop like you've experienced, why it's not immediate.

1 Week After Botox to Forehead and Frown Lines my Brows Have Started to Droop, Is this Likely to Get Worse?

Answers (7)

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