Correcting Uneven Eyebrows from Dysport

In my practice, Dysport usually takes within 6 to 36 hours to work, so give it 3 days to be safe.  Follow my good friend, Dr. Julio Garcia's recommendation, inject the side that is higher with about 5 units and this will lower the elevated brow within a day or so.

In the best of hands, this is not an unusual problem.  I always tell my patients that this is possible and the second injection is on me.  That way, the patients keep coming back to me because I take responsibility for the minor inconvenience they have gone through by having one eyebrow elevated for "x" number of days.  If you charge them for the touch up, ultimately, they won't be happy with you.  Don't forget, happy patients send you a lot of patients.  Unhappy patients cost you a lot of patients.

You can always make brows come down with neurotoxin, but you cant make them come up until it wears off. Always note the brow position and asymmetry in the chart, prior to injection and whether the patient plucks her eye brows prior to injection. Therefore, if there is resulting asymmetry  after injection you know it existed before.

That being said, I tell my new patients it takes me one to two treatments to get it the way they like it. I have the patient elevate their brows to see where the muscle ridges of the frontalis are,and inject into them while they are contracting.  The injection is over the brow,1 to 2 cm above it., usually in 3 locations with the central injection being higher than the other two. Ten units for one eye brow is what I would start with. Start slow  and see the patient back in 10 to 12 days and titrate if more is needed. Once you have your patients individual dose noted, subsequent  treatment will be easy. It is difficult however, to correct preexisting brow asymmetry with neuro-toxin.

As the others have mentioned, make sure you have allowed sufficient time for the dysport to take effect which is generally two weeks. Your next criteria is to determine if the low brow is too low or the high brow is too high. In the former, you maywnat to leave the high brow alone. IF the high brow is too high, then you can lower it as suggested below with introduction of 5 units into the lower frontalis approximately one finger breadth above the brow.

I agree with the other authors.Since the frontalis muscle elevates the brow, weakening this muscle will depress or lower the brow. Generally, about 5 units will achieve the desired degree of correction although it would be useful to check the treatment record to note the dose of Dysport utilized in the initial treatment session.

Thank you for your question. Dysport typically lasts about 3-4 months.  Brow ptosis can occur when an injector uses to high of a dose when treating the forehead muscles or when the forehead is injected too low.  I recommend following-up with your injector to discuss your concerns as it may be possible to raise your brow with touch-up Dysport. Best of luck!

Injecting 2.5 units to 5 units in the mid to upper brow region on the brow that is higher usually will relax the higher brow so that they are more even.

If one brow is a bit higher and both raise the forehead, I would consider injecting a little bit over the side that is stronger or more active to even them out.

The easiest way to address this would be to inject some dysport or Botox into the Frontalis muscle above the elevated eyebrow.  If you see a brow line in resting position that is elevating the affected eyebrow, inject that line.  If not, have the patient lift their eyebrows and assess where the deepest brow crease above the area of the brow elevation is and inject there.  I would start with a very low dose of 5 units of dysport and give more if it is needed at least 4 days later.

There are two muscles that control brow position. The orbicularis muscle, a muscle that surrounds the eyelid and is under the brow. It is the muscle that helps to close your eyes forcefully. The second muscle is the frontalis, which lifts the eyebrows. There are several options for this problem:

1. Do nothing...botox is temporary and will resolve with time

2. Inject some botox into the frontalis muscle above the brow. That can help to lower the brow...Its results are not slam dunk predictable but may help a bit.

First, you need to wait 1-2 weeks to be sure it has taken full effect on both sides. This is a simple problem to correct. If the lower brow is not creating a heavy brow appearance i.e. you like its position, then you can simple put 5-10 units above the higher brow. Remember to stay at least 2 cm above the orbital rim to avoid chance of ptosis. This problem will occur with Botox or Dysport. As an new practitioner, be sure that you get good training with hands on with experts in the field of dermatology. Contact the company and ask that they send a highly experienced physician to your office to further train you. If you contact Medicis and live in the United states, I am one of their physician trainers and if you are a plastic surgeon, dermatologist, facial plastic surgeon or oculoplastic surgeon I will be happy to come to your office to ensure that you are trained well to avoid any problems as well as learn how to manage them should they arrive.