Botox five days ago, when eyebrows raised very spock-like and one higher than other. (Photo)

Thank you for your question. You submitted one photo, and state when your eyebrows are raised after undergoing Botox® 5 days prior, you have a Spock-like appearance. You are concerned about going back to the original doctor because you’re afraid it will make the situation worse. You further describe you had the Botox® done in your forehead and frown lines, and the doctor had done a conservative dose so that wouldn’t be frozen, but say the frown lines are still there. You want to know if this is going to get better or worse in the next few days.
I can share with you my limited assessment from this photo, and how I would typically counsel patients in my practice in understanding what’s going on with Botox®. A little background: I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial plastic and reconstructive surgeon. I have been in practice in Manhattan and Long Island for over 20 years. Botox®, Dysport, and Xeomin are neurotoxins in my practice that have been significant, and continue to grow for the duration of my years in practice. My specialty of oculoplastic surgery were among the first doctors to use botulinum toxin, and so I’ve been using Botox® for patients since 1993. It is very important when I counsel my patients about the use of Botox® that I try to help them understanding the principles of what is being done.
When you had the treatment done for forehead and frown lines, the doctor’s goal was to still have some activity. There are specific muscles that are important in this area. It is perfectly rational and reasonable to be conservative to at least allow for some movement. Often, patients fall into one of two camps: one camp wants absolutely no movement at all, and the other wants to have some movement with expression.
The anatomy is the key to understanding this. There’s a muscle that lifts the eyebrow called the eyebrow elevator, or the frontalis muscle. The muscles responsible for the forehead lines are the corrugator, and procerus muscles, which are referred to as eyebrow depressors. There’s a balance to reduce the activity of the frown lines to go downward and inward. At the same time, you want to minimize the exaggerated effect that can result if you don’t adequately and properly relax the forehead muscles. In certain areas, they can potentially overact, so you get this arching otherwise known as the Spock appearance.
I understand your hesitation about going back to the original doctor, but I can tell you that in my practice, I deal with new Botox®patients by seeing them again in two weeks. The reason is Botox® has its usual effect around 3 days after injection, and the peak effect is at two weeks, which means you still haven’t realized the full effect of the treatment. Now can it get better or worse? It takes two weeks to see, and I understand you would be away on a holiday.
You can reach out to the doctor as it’s a very straightforward issue to resolve. The lines you see above the peak of the Spock eyebrows are referred to as comma lines. It is very straightforward to get micro doses of Botox® to allow for relaxation of some of the more superficial fibers of the frontalis muscle, while at the same time maintaining some movement of the muscle.
My point again about the two weeks follow-up is there is a process of getting to know every patient. A lot of people think of injectables like commodities where it’s equal everywhere you go like buying appliances, but the reality is there is so much nuance in doing this in a way that is right for the individual patient, and there is a “get to know you” process I value in helping my patients achieve an optimal look. Within the ever growing field of ways to do Botox®, even in an area as straightforward as the forehead, there are many nuanced approaches to deliver the Botox® in a way to give the best result for the patient. As I was referring to earlier, there is also the nuanced micro dose, doing things in a way so it looks natural, and still get an ideal outcome.
I would say give your doctor a chance to potentially help you. If you’re still not comfortable, find another doctor who is very experienced with Botox® so you can at least deal with those comma lines. I recommend you find someone who you feel comfortable with, and try to maintain that relationship so that doctor and you work together in a way that can be consistent. Botox® requires maintenance, so coming in every 4-6 months, depending on what kind of look you want to maintain, is going to be a regular thing for you, so you should find someone you’re comfortable with. I hope that was helpful, I wish you the best of luck, and thank you for your question.
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It's possible you're not looking at your final results just yet, so give it a few more days. Regular facial expressions, like raising your eyebrows, will work a bit differently after BOTOX® paralyzes some of the muscles normally used, so that might take some getting used to. As for your frown lines still being visible, most plastic surgeons start off with a conservative approach to see how you respond. If you're still not satisfied with your results by the time you're back from vacation, you can contact them for a follow-up. Best of luck!

In my experience, the full result of Botox takes 2 to 3 weeks. If your Eye Brows are still raised and uneven at that stage, it would be prudent of you to return to your doctor as "spocking" and assymetry can be reversed with small amounts of Botox accurately and strategically placed in the Frontalis muscle of your forehead.