Botox Muscular Atrophy Between Brows - What can I do to fix this? (photos)

Question

I’ve been getting Botox regular for about 7 years now and am starting to develop a hollowness between my brows, almost as if it looks dented. What can I do to fix this? My Botox injector said no one in her network has experienced this. While it started as something very minimal it is now noticeable in all photos.

James R. Gordon, MD, FACS, FAAO · Answer

Thank you for sharing your question and posting your photos. With careful placement of fillers you might be able to fill in your “dent”. Make sure an experienced oculofacial surgeon assists with your problem due to the issues of blood vessels in this location. Good luck!

Nelson Lee Novick, MD · Answer

Without knowing exactly how much Botox was injected in the region and how often it was done, I can only surmise from the history that some degree of muscle atrophy has occurred there accounting for the indentation. If this is indeed so, then, in the hands of a highly experienced board certified cosmetic dermatologist injector, an appropriate cohesive, low viscosity HA filler can be used to elevate and smooth the indentation.  The is a high vascular region, so it is imperative that an experienced injector be sought ouit. Only this past Thursday, I saw in follow-up a patient I treated with a similar history who was treated as described above with complete resolution of the indentation. Hope this helps.

Niro Sivathasan, MBBS, MRCS, FAACS · Answer

It is well-established that muscle atrophy (shrinkage) happens consequential to the administration of botulinum neurotoxin (BoNT-A) in the local area. This is said to be temporary and reversible. However, it serves to reason that long-term chemodenervation (paralysis due to the use of BoNT-A), especially significant amounts in the same area, would cause local muscle-thinning; hence causing a relative depression compared with surrounding areas. So, what is the solution in your case? Firstly, stop paralyzing the concerning area (between the brows), i.e. give the muscles are break, and also consider the use of hyaluronate fillers (type low G') to correct the contour-deformity and to keep the skin taut (appropriate consent must be undertaken by the treating physician due to some risks). Also, the use of energy-based devices that would encourage skin remodelling (to improve thickness and tightness) should be undertaken pan-facially, for multiple reasons.

Darryl J. Blinski, MD · Answer

Great photos posted. I rarely see this Botox induced hollowness. I have treated with HA fillers or nano fat grafts. Fee from $800-$1,200. Best yo virtual consult with

Reuel Aspacio, MD, FAAD - Account Suspended · Answer

Hi there,

That wouldn't be caused from Botox.  Its just the way your muscle is.  Or perhaps you had a steroid injection in the past?  But that can easily be taken care of with a soft filler.    See an expert injector!

Best of luck!

Botox Muscular Atrophy Between Brows - What can I do to fix this? (photos)

Answers (6)

Answer: II’s hollowness due to Botox

Answer: II’s hollowness due to Botox

Answer: Filler

Answer: Filler

Recommended reading

Everything you need to know about Botox

Our mission is to create a world where every investment in modern beauty is Worth It.

Botox Muscular Atrophy Between Brows - What can I do to fix this? (photos)

Answers (6)

Answer: II’s hollowness due to Botox

Answer: II’s hollowness due to Botox

Answer: Filler

Answer: Filler

Browse related questions

Recommended reading

Everything you need to know about Botox

Our mission is to create a world where every investment in modern beauty is Worth It.