Brows uneven after Botox. How to fix lower eyebrow? (photo)

Question

The lower eye and brow is a prosthetic eye, but this has never happen to this extreme before. What can I do?

Jason Emer, MD · Answer

Botox results last 3-4 months. In the mean time, venus legacy and thermage treatments can soften results. See an expert. Best, Dr. Emer

Kenneth Oleszek, MD · Answer

Sometimes the brows will be lower after a Botox treatment.  And sometimes it may be just one side.  There is a common follow-up treatment using Botox to treat the brow depressors on the lower side that can elevate that brow.  This follow-up treatment is common and should be offered by your Botox Doctor.  I would call them and show them the same photos and schedule a follow-up appointment.
Good Luck,
Ken Oleszek, MDLa Fontaine AestheticsDenver, Colorado

Mark L. Mazow, MD, FACS · Answer

The unevenness to your brows is related to volume differences between your two sockets related to your eye loss and the prosthetic eye. These can cause upper eyelid and brow asymmetry. I would see your Board certified Oculatrist and consider a referral to an Oculoplastic surgeon to examine you and determine whether there is anything that can be dome to equalize the volume. Good luck.

Amiya Prasad, MD - Account Suspended · Answer

Thank you for your question. You’re concerned about your brows being uneven after Botox®, and state the lower brow is the side of a prosthetic eye. You submitted photos with your face at rest, and with elevation of your brow. It becomes more clear with one photo that the right brow goes up, and the left brow does not, so you want to know how to fix the left brow.  
I can share with you my approach to helping patients 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. I have been treating patients with Botox® since 1993. Our specialty was among the first group of doctors to use Botox®, and since then the world has expanded with many uses of Botox®. 
Going over the physiology and basis of what you’re experiencing, you’re generally dealing with forehead wrinkles. There’s a muscle called the frontalis which has a vertical orientation, so when this muscle is engaged, the eyebrows go up. Very often, when people have a certain habit, or with aging, or in some situations where their eyelids are drooping, they use that muscle a lot. Strategic placement of Botox® can help reduce the lines. Some people prefer no muscle activity on the forehead, so they have a very smooth forehead, but one of the consequences of that is the brows can droop. 
Judging by the photo, it appears you just have some residual activity on the right side, and no activity on the left side which is the explanation why the left brow doesn’t come up at all. The unfortunate reality is you cannot reverse Botox®. This requires time to let the Botox® wear off on that side so the brow comes back up. 
Every doctor who administers Botox® can relate to this type of situation because dosing can have a variable impact, even when you know the patient for a long time. It is advisable to bring this to your doctor’s attention. If this is the doctor you’re going to regularly, the doctor will know to adjust the dosing and placement for next time. 
In our practice, when we do Botox® whether for wrinkles around the eyes, frown lines, forehead, lip lift, chin dimples, or another of its many uses, we have patients come back after about 2 weeks. This is to assess the effect, and see if we need to enhance, or at least document what is the optimal dosage and placement for that patient. That’s an important thing that hopefully you have in your situation. 
I think that if your concern is mostly about symmetry, then one could consider additional Botox® over the right brow so it comes down a little lower. That may not be desirable because you may feel the brows are too low. If your eyebrows are much too low, then you’re not going to like that either. 
I think it’s very important for you to discuss this with your doctor. Review the dosage, review the amount, and allow some time to pass. The Botox® will wear off, then you can allow more conservative treatment on that left side the next time. I always tell my patients it’s better that you come back in two weeks so I can add, because I can’t subtract with Botox®.  I hope that was helpful, I wish you the best of luck, and thank you for your question.This personalized video answer to your question is posted on RealSelf and on YouTube. To provide you with a personal and expert response, we use the image(s) you submitted on RealSelf in the video, but with respect to your privacy, we only show the body feature in question so you are not personally identifiable. If you prefer not to have your video question visible on YouTube, please contact us.

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