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.