Depressed Inner Brow After Botox Will Glabella Injection Help?

Question

Hi. I received 16 units of Botox to my forehead and no where else 2 weeks ago (by board certified derm). I now look bad, my inner brow region and between nose is heavy and prominent and has pulled my inner eyebrows down so I look caveman like and very odd. My arch is a bit too exagerated and lateral brow is up too high. Will getting injections in my glabella region help me look more normal?

Anil R. Shah, MD · Answer

Knowledge of facial anatomy will play a role in your botox results being effective, placement in the wrong muscle can cause central drop.  Medial brow ptosis or descent of the central brow can occur for several reasons:
-Botox placed too low within the frontalis muscle along the forehead including central forehead.  The frontalis muscle elevates the forehead and by decreasing activity here the central brow can drop
-Botox placed too superficially along the corrugator.  The botox will again impact the frontalis muscle and paradoxically lower the central brow.
Botox is best injected by an experienced injector to lessen wrinkles while improving facial appearance.

Kenneth Hughes, MD · Answer

Glabellar injections to lift the medial brow may be what is needed, but injection to lateral forehead may give more balance as well.

Ron Shelton, MD · Answer

If someone's brow is depressed after Botox on the forehead, Botox injected in the glabellar region of the lower forehead may help lift the eyebrows and the sagging mid skin.  Some patients also benefit from the lifting that Ultherapy can induce and as we age, there is a greater tendency for the forehead to droop. This diminishes the ability of the doctor to treat the horizontal lines of the forehead without making it sag more. The Ultherapy, by helping lift the forehead, might allow the doctor to continue injecting the forehead without sagging. The result of Ultherapy does not become apparent immediately and it can take six or more months to be seen.

	The information provided in Dr. Shelton's answer is for educational purposes only and is not intended to constitute medical advice.  The information provided should not be relied upon as a substitute for consultations with a qualified health professional who may be familiar with your individual medical needs.

Sam Naficy, MD, FACS · Answer

Without viewing photo's it is very difficult to answer this question. You should consider posting photo's for better assessment.

Robert F. Centeno, MD, FACS · Answer

Thank you for your question.  The balanced interaction between the facial muscles is critical to a natural result after botox injection.  Injection to your forehead muscles in isolation is the cause of your findings of a heavy medial brow and peaked lateral brow.  Treatment of the glabella, lateral canthus and perhaps lateral frontalis at specific doses should help put things back in balance.  Seek out a very experienced injector for this type of revisionary treatment as this finding is technique related, not product related. Good luck.

Jason D. Bloom, MD, FACS · Answer

What has most likely happened is that you received too much Botox in the central forehead or frontalis muscle that has weakened it and not allowed it to elevate your brows and instead it is heavy. This can also be caused by too low of an injection in the central forehead. I am surprised that your lateral brows elevated without glabella or crow's feet injections, but this could be a relative from not injecting the forehead laterally.

Jacque P. LeBeau, MD · Answer

I would suggest returning to the physician who performed the initial injection.  Sometimes it may be necessary to treat the lateral forehead with small amounts of botox as well to achieve a balanced and natural result.  

	Best Regards,

	Jacque P. LeBeau, MD

Martie Gidon, MD, FRCPC, FAAD · Answer

You should return to your dermatologist for assessment.  He may be able to adjust your eyebrows now and will know how to place the injections next time.

Eugene J. Sidoti, Jr., MD · Answer

Without pictures or direct exam it is very difficult to make specific recommendations. From your description it sounds like your initial treatment was concentrated on the central portion of the frontalis muscle and under-treated the lateral frontalis. This would cause the lateral brow to over-elevate as the lateral forehead still functions while the central forehead does not. By contrast the medial brows would seem low and "heavy" appearing.

	Glabellar injections would not likely improve this, however judiciously applied Botox to the lateral brow may improve the situation. I suggest that you seek consultation from a provider experienced in injecting as this requires very specific placement to avoid making the situation worse. Of course if you do nothing, the situation will eventually resolve on its own but will take several months.

Hratch Karamanoukian, MD, FACS · Answer

Don't get any more Botox for correction by the same doctor. Wait 4 months until it disipates and show current pictures to new Botox injector (another Botox doctor) and address the issues to avoid similar outcome which is "not your vision of new self". Go for your new 'realself' as they say ...

Depressed Inner Brow After Botox Will Glabella Injection Help?

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