Eyebrows have changed shape and dropped very low after receiving botox 12 days ago. Is there anything that can be done to fix?

Question

I got 12 units throughout my forehead of Botox for the very first time 12 days ago because I wanted a refreshed look. I was told this was a conservative amount. My forehead is frozen and my eyebrows have dropped so low causing hooded eyes. I feel so ugly with botox and don’t look like myself anymore. I look angry all the time. Is there anything that can be done to fix this? How long does this look typically last? went to one of the best plastic surgeons to have this injected too I’m so bummed :(

Brock Ridenour, MD · Answer

In my opinion, 12 units of Botox in the forehead is a moderate treatment, not a light dose.  The frontalis muscle (forehead) is the only upward supporting muscle of the brow.  Even modest doses can cause a little drooping. In the future I would suggest dropping to 6 or 9 units. In the meantime, you might see a small improvement in brow position by treating the downward pulling muscles that act on the brow - corrugators, procerus (frown muscles) and temporal portion of the orbicularis muscle (crow's feet). If those have already been treated you will have to wait a short time for your brow to recover. Fortunately, a small droop frequently lasts only a few weeks. Best wishes. You will be happy when you discover the ideal dosage for your face.

Jason Emer, MD · Answer

Sorry to hear about your experience. Botox results typically last up to 3 to 4 months and can be softened with Venus Legacy and Thermage treatments. I recommend following up with your surgeon or getting a formal evaluation with a cosmetic dermatologist. Best, Dr. Emer

Nelson Castillo, MD · Answer

Thank you for sharing your question and photographs.  Unfortunately it appears that you have suffered with some sagging of your eyebrows resulting in heaviness of the upper eyelids.  This will wear off in time but you may see some temporary improvement with treatment to the crow's feet region and/or glabella.  Based on your sensitivity to the product it would be best to let your injector see your results so that future treatments can be tailored accordingly.

Camille Cash, MD · Answer

I'm sorry you are unhappy with your Botox treatment.  The 12 units you mentioned is a conservative amount depending on where you were injected.  I encourage you to visit with your injector to discuss your concerns.  More Botox would not be advised but notes can be taken to avoid any unwanted effects from future treatments.

Michael Pelster, MD · Answer

Although Botox is not reversible, injections into the lateral brow (often in combination with treatment of the crow's feet, or lateral small lines), can elevate the brow to some degree.  This is something to consider.  Please seek re-evaluation with your treating physician to discuss your concerns and seek correction, if possible.  
Best of luck!

Carmen A. Traywick, MD, FAAD · Answer

Botox locks the release of a chemical called acetylcholine, which triggers the muscle contractions that create wrinkles. Botox essentially paralyzes the muscles and stops them from contracting. Results from these treatments are visible within 3-14 days with results that can last anywhere from 3-4 months. Unfortunately, Botox cannot be reversed. Follow up with your injector at 2 weeks to discuss any questions or concerns that you may have. Hope this helps.

Lesley A. Rabach, MD · Answer

I am so sorry to hear this happened to you. Once in a blue moon patients respond VERY well to a treatment. 12 units is very low but not for you in particular it seems (not a bad thing). The placement may need to be adjusted next treatment.

Do not be discouraged. Next time ask for less injection and show your physician how you responded. It is great feedback for the next routine injection as it can be tailored.

Richard Ort, MD · Answer

Rest assured that the Botox effects will wear off.  I typically would not give 12 units to the forehead in a first time patient. Usually my forehead dose ranges from 5-10 units.  As the Botox starts to wear off, you will notice gradual return of your muscle function and the ability to raise your eyebrows.  You should go back to discuss with your doctor. Regards,Dr. Ort

Alex Eshaghian, MD, PhD · Answer

Thank you for your question and for sharing your photographs sononicole. I understand your concern. Botox is a purified protein used to address wrinkles associated with facial expression. When injected into the skin Botox will relax the muscles and smoothen out the overlying wrinkles. The most common areas of treatment are in the upper face. These include the horizontal lines seen on the upper forehead when one raises the brows, the vertical lines seen between the brows when one frowns (frown lines), and the crow's feet seen around the eyes when one smiles.
It is difficult to make an assessment without knowing the dose used and the exact placement of the product. However, I hope the information provided here is useful.The pivotal studies used 20 units of Botox in the forehead area above the brows to address the horizontal lines seen when one raises the brows. These studies demonstrated that the peak results are seen 14 days after the treatment and most people enjoy their results for 3-4 months. At that point, a maintenance treatment is recommended. While some people start to see results as early as the next day, it can take two weeks for full results so patience is important. We have our patients return two weeks after their treatment to assess their results via photographs. At that time additional units may be added if necessary. 
The pivotal studies for the horizontal lines on the upper forehead were published many years after doctors had been using Botox. In these studies, 20 units of Botox were used to treat this area. However, in my experience I find that anywhere from 10 to 20 units works well in this area. For patients with narrow foreheads a lower dose may be used and those with a broad forehead generally require higher doses. I have also found that the full results in this area are seen by two weeks. Therefore, we have our patients return two weeks after their treatment to assess the results via photographs. At that point additional units may be used if further enhancement is desired.
When patients present with concerns about specific wrinkles in the upper face such as the frown lines, I always assess and usually treat the other wrinkles in the upper face including the horizontal forehead wrinkles and crow’s feet. The reason is to maintain a harmonious and natural balance to the appearance of the upper face. The muscles in the glabella which are responsible for the formation of the frown lines serve to pull down on the inner brows when a person frowns. Similarly, the muscles around the eyes which are responsible for the formation of the crow’s feet seen when smiling (orbicularis oculi) are also responsible for pulling down on the brows, but in this case the outer brows. On the other hand, the muscle in the upper forehead which is responsible for the formation of the horizontal forehead wrinkles when a person raises the brows (frontalis) serves to pull the brows upward. If one of these muscles is relaxed with Botox and the others are not, the other muscles will still be active. This will lead to an unbalanced and unnatural appearance of the upper face where the brow can be elevated, depressed, or uneven in shape or position. Therefore, I recommend that my patients take a global approach to the upper face when receiving Botox treatments and treat all three of these areas. Sometimes bunny lines on the bridge of the nose are also treated.
If I had a patient with the concern described here I would want to know where the product was placed. Based on the photographs I suspect that all of the product was placed in the upper forehead. In this case taking a global approach and placing some product between the eyebrows and around the eyes should lift the brows and improve the heavy feeling and angry appearance.With any injection, there are risks such as pain, bleeding, bruising, redness, swelling, tenderness, and infection. We take special precautions to minimize these risks such as using a painless technique. We also treat bruises with a laser as early as the next day. Bruises usually resolve within two weeks if untreated. After a laser treatment bruises usually resolve in 1-3 days, but may still take two weeks for full resolution. In addition to these risks, with Botox there is also a risk that the product spreads or diffuses to nearby structures. Spread to nearby muscles can lead to side effects such as the temporary appearance of droopy eyelids or a temporary asymmetric smile.
  
After a Botox treatment, I recommend that my patients avoid heat exposure, alcohol consumption, and strenuous exercise for 24 hours and not lie down flat for four hours. This is because all of these activities may possibly lead to the movement of the product and consequent side effects such as droopy eyelids. Although there have been no definitive studies shown that these actually occur and some physicians do not provide such aftercare instructions, in the absence of data I err on the side of caution and recommend that my patients avoid such activities.
  
Please consult with a doctor for specific recommendations. Good luck!

Pamela Stuart, MD · Answer

If you are unhappy with your Botox results, it will be important to share your concerns with your injector so he/she is aware of your expectations. Botox typically last 3-4 months. Often a heavy brow can be partially corrected by placing additional Botox strategically in the tails of the eyebrow, but it will depend also on where your original injections were placed. Since you mention that your injector is “one of the best”, he/she should be experienced enough to work with you to help you achieve the results you are wishing. In any case, the Botox will lose its effect gradually over the next 3-4 months and your eyebrows will revert to their previous position.
Best wishes,
Pamela Stuart, MD

Eyebrows have changed shape and dropped very low after receiving botox 12 days ago. Is there anything that can be done to fix?

Answers (14)

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