Eyebrow drop after Botox 1 week ago. (Photos)

Question

I had 55 units of Botox injected 6 days ago. 20u for frown, 10u forehead, 12.5 u crowsfeet each side. Today I noticed a cignificant drop of my right eyebrow. What else can I expect? Are there any more changes coming? Is it going to drop more? Is my left brow going to drop too? How long will this last? Thank you.

Pejman Aflaki, MD · Answer

Hi,
This is one of the frustrating problems associated with Botox injection to frontalis muscle (forehead). This muscle is responsible for raising your eyebrows and in doing so creates the horizontal lines or wrinkles in forehead. Injecting Botox to forehead paralyzes this muscle and therefore improves the horizontal lines and if given early enough in late 20s or early 30s, prevents this lines from happening. If injected too much or too close to the eyebrows, Botox can cause difficulty in raising the eyebrow or eyebrow ptosis. This may get better spontaneously within a few weeks. Alternatively, a small dose of Botox injected under the lateral brow area may counterbalance the effect of weak forehead muscle and improve your brow position. I would go back and check with the doctor that gave you the injection.

Harold J. Kaplan, MD · Answer

Hello,The amount of Botox you received does not sound excessive; however, much depends on the muscle movement at the time of your treatment which dictates the dosing.  The forehead is a tricky area for the very reason of what you are experiencing.  We encourage patients to retain some movement of the forehead (some lines) in order to avoid a heavy feeling and look to the brows and eyelids.  The transition for this area may take up to 2 weeks.  However, at this date, it would appear that you will need a follow up visit to address the asymmetry.  Your injector will also want/need to know what you are experiencing to avoid this in the future by using less units or placing higher up in the forehead to avoid how the right eyebrow is too rested.

Ramandeep Sidhu, MD · Answer

Sorry for the uneven result. If you get regular botox then this might be your final result since in my practice people who do regular botox will get their maximum result by day 6. Now for the treatment there are two options:
1) Leave it the way it is and and 1-2 weeks the right side will start improving
2)If the uneven look really bothers you, small dose of botox can be injected on left side to lower the left eyebrow so it looks even. This won't give you the lift but at least it will look even. 
I do recommend going back to the injector so they can see the uneven result and adjust the areas for next time so you don'e get similar results. 
Good luck!

Kenneth D. Steinsapir, MD · Answer

The goal of botox treatment should not be total paralysis.  This was a whopping dose of botox.  The forehead looks flattened.  To goals should not be paralysis but brow shaping.  It is no surprise that your eyebrows are down.  I encourage you to study my Microdroplet Lift method.  It actually does not treat the forehead at all.  The muscle up there is responsible for elevating the eyebrows.  Treatment up there causes the eyebrows to fall. The Microdroplet Lift targets only the eyebrow depressors and creates browlift and reduces forehead lines by reducing the amount of work they need to do.  You get a brow lift without the freeze.

Jason Emer, MD · Answer

It takes 1-2 weeks for final results with Botox. If you're unhappy with your final results, venus legacy and thermage treatments can soften results. Botox results will resolve in 3-4 months. See an expert. Best, Dr. Emer

Daniel Barrett, MD · Answer

Dear Solo77,Botox is generally an on off switch for muscle activity. I get a fair amount of actors/actresses in my practice that are looking to reduce wrinkles but keep some expression. Most of patients see first changes after 4-7 days and the final results after 10-14 days.It depends on the amount of Botox and area where it is injected but it usually last for 3-4 months.Daniel Barrett, MD, MHA, MS 
Certified, American Board of Plastic Surgery  
Member, Am. Society of Plastic Surgery

Jacob Boeckmann, MD · Answer

A heavy forehead or brow asymmetry are not uncommon complaints following Botox to the forehead wrinkles.  The frontalis muscle is the only brow elevator and is responsible for horizontal forehead lines. Botox improves lines and wrinkles of the upper face by weakening the muscle's ability to contract. Some patients have a naturally low position of the brow so in those patients conservative doses must be used in order to avoid brow ptosis. Unfortunately, there is no way to reverse Botox, but with time the muscle activity will improve and the heaviness will go away. 
Brow asymmetry can also occur from uneven uptake of the Botox into the forehead muscle. Botox can take up to 7-14 days for the complete effects to take place but if asymmetry persist this can typically be corrected with a touch up dose to the forehead muscle. I would contact your treatment provider for an evaluation can be performed to determine the best course of action.

Lisa Freeman, MBBS · Answer

Thanks for your question. If the the amount of botox in your forehead was too much, and/or if the botox was injected less than 2cm above the brow, it can cause the brow to drop. Changes from botox can be seen up to 2 weeks post injection, but usually by 6 days you would have seen most of the effects, especially as you have seen some changes. It is probably best to go back to your treating doctor 2 weeks after the initial injections as the full effects of botox will be evident then, and it will be important for your doctor to know your response so that treatment can be adjusted for next time. It may improve a little over the next few weeks on its own. There is no good treatment to rectify it, just time for it to wear off.

Shaun Patel, MD · Answer

Sorry to hear about your experience. It can take 7-14 days to see the full effects of the Botox treatment. I would followup with your treating physician to discuss your results.

Melvin Elson, MD · Answer

The dose is not excessive but it looks like you had a  total response and may be too flattened and that may have caused the problem. It will probably get better on its own and there is no good treatment but in the future be aware that your response is significant

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