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.

Unfortunately, the Spock eyebrow is not uncommon after Botox injections.  However, it can easily be fixed with a small quantity of additional Botox injected into the forehead (frontalis) muscle above the point of the arched brow.
The maximal effect of Botox is at 2 weeks, so you might still see an improvement in your frown lines.

Thank you for your question and photo. Though unfortunate, this is not an uncommon issue after getting Botox. It is an easy fix to help with the "Spock" brows. Please return to your injector and they can add just a little Botox in the forehead to help relax the sharpness of the brow. If you choose not ho return to your original injector, then the effects will take about 3-4 months to wear off. Going to a different injector is an option, and  any good experience injector will know exactly how to correct this. Good luck.  

"Spocking" is very common when the forehead is injected in the middle but not on the lateral ends of Frontal muscles- it will subside spontaneously within 2-3 weeks
It can be treated with 1-2 units injected in the pick of that brow spock to flatten faster

although that effect will resolve in about 4 months, you should go back to your Dr. So he can give a little dose of Botox above the eyebrows to let the brows come down

This is a common occurrence and is usually the result of faulty technique (although it can happen to anyone). You want to wait 2 weeks for your final results regardless so when you get back from your vacation, schedule a consultation with a board certified plastic surgeon or cosmetic dermatologist. The issue is easily fixed. Best of luck. 

This can easily be fixed using a small amount of Botox which will need to be injected above the arch of the eyebrow. I wouldn't blame the injector as this can sometimes happen to the best of us. 

Thank you for your question and for sharing your
photograph JB4045. I understand your concern. Botox is a purified protein
used to address wrinkles associated with facial expression. When injected into
the skin Botox will relax the muscles and smoothen out the overlying wrinkles. The
most common areas of treatment are in the upper face. These include the
horizontal lines seen on the upper forehead when one raises the brows, the
vertical lines seen between the brows when one frowns (frown lines), and the
crow's feet seen around the eyes when one smiles.It is difficult to make an assessment without a
formal exam in the office where I can view the skin in multiple angles and observe
wrinkles formed with facial expression. However, I hope the information
provided here is useful.The appearance of frown lines is variable from
person to person. Usually they are in a vertical orientation but sometimes they
can be oblique and sometimes a horizontal line is seen across the upper portion
of the nasal bridge. The most common variation is to have two parallel lines,
hence the common term "11's" to describe them. But some people have
one, three, or more lines. Some people also will see a bulge in the area when
contracting the muscle. This bulge is smoothened out after a Botox treatment.The pivotal studies used 20 units of Botox in
the glabella area between the brow to address the frown lines. These studies
demonstrated that the peak results are seen 14 days after the treatment and
most people enjoy their results for 3-4 months. At that point, a maintenance
treatment is recommended. While some people start to see results as early as
the next day, it can take two weeks for full results so patience is
important. We have our patients return two weeks after their treatment to
assess their results via photographs. At that time additional units may be
added if necessary. There have not been such studies published for
the horizontal lines on the upper forehead. However, in my experience I find
that 10-20 units works well in this area. For patients with narrow foreheads a
lower dose may be used and those with a broad forehead generally require higher
doses. I have also found that the full results in this area are seen by two weeks.
Therefore, we have our patients return two weeks after their treatment to
assess the results via photographs. At that point additional units may be used
if further enhancement is desired.When Botox is used in the upper forehead, if the
dose is too high or the placement is too low it can result in the feeling of
heaviness in the eyebrow or even lower the position of the brow. In order to
reduce the risk of this possibility, I use a conservative dose in the area and
place the product high on the forehead, sometimes near the hair line. Additionally,
I recommend that my patients simultaneously receive a small amount Botox
between the brows and at the corners of the brows. This will relax the muscles
that pull down on the brows to counteract this effect and provide a harmonious
balance to the position of the brow. The results are assessed two weeks after
the treatment. If there is any asymmetry a small amount of Botox can be placed
in the upper face for correction.Sometimes after a Botox treatment a peaked
appearance of the eyebrow is seen. This is sometimes called the Spock or
Mephisto look, which makes a person appear surprised or sinister. It is also
called the Jack Nicholson look, after the appearance of his eyebrows. This can
occur if the muscles that pull the eyebrow down are relaxed with Botox. It can
also occur if the upper forehead only is treated. In this case the inner
portions of the muscles are relaxed preferentially over the outer portions of
the muscle. This allows the outer portions of the muscle to pull up on the tail
of the eyebrow. While some people desire this appearance, others do not. This
effect can be corrected by placing a small amount (1-2 units) of Botox in the
upper forehead approximately midway between the eyebrow and the hair line at
the peak of the brow. This relaxes the muscle that pulls up on the tail of the
eyebrow, thereby restoring a natural appearance.With any injection, there are risks such as
pain, bleeding, bruising, redness, swelling, tenderness, and infection. We take
special precautions to minimize these risks such as using a painless technique.
We also treat bruises with a laser as early as the next day. Bruises usually
resolve within two weeks if untreated. After a laser treatment bruises usually
resolve in 1-3 days, but may still take two weeks for full resolution. In
addition to these risks, with Botox there is also a risk that the product spreads
or diffuses to nearby structures. Spread to nearby muscles can lead to side
effects such as the temporary appearance of droopy eyelids or a temporary
asymmetric smile.After a Botox treatment, I recommend that my
patients avoid heat exposure, alcohol consumption, and strenuous exercise for
24 hours and not lie down flat for four hours. This is because all of these
activities may possibly lead to the movement of the product and consequent side
effects such as droopy eyelids as described above. Although there have been no
definitive studies shown that these actually occur and some physicians do not
provide such aftercare instructions, in the absence of data I err on the side
of caution and recommend that my patients avoid such activities.Please consult with a doctor for specific
recommendations. Good luck!