Not able to lift my inner brows ("Mr. Spock") look and asymmetry after botox brow lift.

Question

I recently had my first injections of botox. I am a 49-year-old woman and wanted to soften the "eleven" lines between my brows and wanted a natural looking medial brow lift. I told my practitioner I did not care at all about the horizontal lines on my forehead. 4 days post injection and I am noticing asymmetry and a slight droop to my left brow. I also notice that when I raise my eyebrows, the center of my brows don't lift up at all. What caused this, and since it is only day 4, will it get worse?

Nelson Lee Novick, MD · Answer

The quizzical, lateral eyebrow elevated look of the Star Trek character Mr. Spock typically results when the downwardly pulling, central depressor muscles in the glabella area have been treated to the point of leaving the motion of the elevated forehead muscles unopposed. A microdroplet or two of additional Botox placed around the height of the Mr. Spock arch can usually take care of this problem quite nicely. As a rule, experienced injectors no longer attempt to "freeze" muscles to the point of creating an abnormally wrinke-less porcelainized look. Instead, the aim is reduce the overactivity of the muscles of facial expression that accompanies aging to a point more reminiscent of their level of activity in youth. As to the  slight droop to the left brow, this might have resulted from some diffusion of the Botox from the glabella to the brow itself, which may explain the brow ptosis you are describing. This will fortunately wear off likely in about one to two months. Going forward, you would do well to seek treatment by a board certified aesthetic physician and make sure to ask to see his/her before and after photos before agreeing to proceed. Best of luck.

Ramiro Morales, Jr., MD · Answer

Thank you for your question and pictures.  Full effect of Botox can take 8-10 days.  Also, I don't know how many units and where exactly they were injected, so it is hard to correctly answer your question.  My advice, is however, to allow full onset of the Botox (at least 10 days), and then if you still have concerns, go to see your PS for any touch ups that are necessary.  Before that is to soon to judge the final result and certainly no further Botox should be injected until the full affect can be appreciated.

Jason Emer, MD · Answer

It is too soon to tell what your final results will be. It can take 1-2 weeks for final results with Botox. If you're unhappy with your final results, you can have a touch up of Botox or soften results with Venus Legacy treatments. Best, Dr. Emer

Guy Cappuccino, MD · Answer

Hello-  this is a common issue I see when Frontalis (the muscle that creates the horizontal forehead lines) is treated incorrectly.  There is an easy fix by just relaxing the outer section of the frontalis to correct the peaked "Spock" eyebrow look.

Matthew Bridges, MD, FACS · Answer

From your photos it is clear that Botox has affected your frontalis muscle,  the muscle that raises the brow.   This can happen if the muscle was injected directly or if the Botox  intended for your frowner muscles  (the ones between your eyes that produce "11s") spread unto the frontalis.   I think the latter may have occurred in your case.   To avoid this,  the frowner muscle injections need to be placed no higher than the upper edge of the brow centrally.   Any higher and they will affect the frontals.  You get the Spock brows because the only area of the frontalis still active is the on the sides above the brow.   When you raise your brows,  it pulls up only on  the outside of the brow.   The only thing to do now othrr than waiting if out is to have a tiny amount of Botox injected in the peaks to weaken the lateral frontalis.   However,  this will probably make your brow nearly immobile,  which might be worse.   The good news is that this will wear off.   This may not get any worse,  but you will have to wait and see.

Nelson Castillo, MD · Answer

Thank you for sharing your question and photographs and I am sorry that your current results have not been what you anticipated.  I would voice your concerns with your injector but would remind you that Botox takes a full 10-14 days to reach maximum effect, so you will need to refrain from revision treatments until then.  When the area between the eyes are treated it can also effect the muscle responsible for elevating your medial brows, you then have unopposed action of the fibers elevating your outer brow, giving you a "Mr. Spock" look.  Once your results have matured this can be evened out with a small amount of Botox above your higher brow to help drop it during animation.  Hope this helps.

Robert W. Sheffield, MD · Answer

At four days you are getting close to the final result ofyour Botox. Every patient has to be treated a little different. I did not see abefore treatment picture but putting this together I suspect the medial browwas already low. The “ Spock look” can be adjusted with a small amount ofBotox. Do not get discouraged because it is an adjustment for you. Communicatein the future that you do not want Botox placed in the lower central foreheadand that probably will solve the problem.

Anne Taylor, MD · Answer

Hello-getting botox is really a learning process for both you and your physician- about how you want to look, and about how your muscles are affected-- so how much is needed.  The good news is you can  even it out with a little more, or wait a bit and it will start to go away on its own. Good luck

Sheryl D. Clark, MD, FAAD · Answer

Dear ebeth614:
  The results you picture and describe occur when Botox is placed high above the brow centrally and/or more dilute Botox is used. Each of these techniques allow Botox to diffuse beyond the muscles of the glabellar complex and into the frontalis muscle. I never see this problem using 100 units of Botox per cc and placing the Botox just above the brow. See the video below for more details.
  All the best,   Dr. Clark

Harry Mittelman, MD · Answer

Thank you for your question and photos. The full effect of botox should been seen within in 2 weeks of injection. Some corrective measure can be done to help soften the "Mr. Spock" look depending on how many units and where the injection were placed. It would be best to wait until the full effects of your initial injection had taken place and contacting your injector for touch ups.

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