Will the Spock eyebrow look lessen? My frown (11) has not changed yet but the vertical lines on my forehead have smoothed out.

Question

Spock Eyebrows following my first botox treatment - noticeable by day 4, now on day 6 and somewhat worried.

Jonathan Kulbersh, MD · Answer

Thanks for the question. Unfortunately, it is difficult to make an assessment without at least a photo of your current results. I can tell you that while you might see some changes shortly after your Botox treatment, the full outcome will not be apparent until about two weeks later. I would wait the two weeks and if you are still unhappy with your results, schedule a follow-up with your injector to see if additional units are needed to achieve your desired result.

Matthew Richardson, MD · Answer

As the Botox takes effect, it is normal for different muscles to weaken at different times.  It can take a full two weeks for the full effect of the injection to take hold, although most patients will see their final results within 7-10 days.  If a patient's eyebrows are still too peaked at around two weeks post-injection, their physician injector can do a touch up and make the eyebrow peaks soften up.  I would always encourage patients to discuss any questions or concerns they might have with their injector.I also always recommend using an expert physician injector.All the best,

Philip Solomon, MD, FRCS · Answer

Hi there,Botox can take up to 14 days to take full affect. A 2 week follow up is recommended and at that appointment, your injector may decide to add extra units to resolve the "spocking".

Sean Hill, MD · Answer

Thank you so much for your question. 
Botox typically takes 3 days on average to work with most effects seen by 5-7 days. I usually tell my patients if they notice anything abnormal or underrated at 3-5 days to reach out to me so we can make appropriate revisions. 
I would say your changes are likely where they are going to be and you should see your surgeon for diagnosis and correction. Best of luck.

Camille Cash, MD · Answer

The final results from your Botox treatment can be seen 14 days after injection.  If you still have concerns at that time, return to your injector for an evaluation.  Sometimes a small touch up of Botox is needed to lessen the "Spock" effect.

Alex Eshaghian, MD, PhD · Answer

Thank you for your question iveseenbetterdays. 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 in the absence of consistent photographs before and after in the same lighting and angles for comparison. However, I hope the information provided here is useful.The appearance of frown lines is variable from person to person. Usually they are in a vertical orientation but sometimes they can be oblique and sometimes a horizontal line is seen across the upper portion of the nasal bridge. The most common variation is to have two parallel lines, hence the common term "11's" to describe them. But some people have one, three, or more lines. Some people also will see a bulge in the area when contracting the muscle. This bulge is smoothened out after a Botox treatment.
  
The pivotal studies used 20 units of Botox in the glabella area between the brow to address the frown lines. 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. 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.
Sometimes after a Botox treatment a peaked appearance of the eyebrow is seen. This is sometimes called the Spock or Mephisto look, which makes a person appear surprised or sinister. It is also called the Jack Nicholson look, after the appearance of his eyebrows. This can occur if the muscles that pull the eyebrow down are relaxed with Botox. It can also occur if the upper forehead only is treated. In this case the inner portions of the muscles are relaxed preferentially over the outer portions of the muscle. This allows the outer portions of the muscle to pull up on the tail of the eyebrow. While some people desire this appearance, others do not. This effect can be corrected by placing a small amount (1-2 units) of Botox in the upper forehead approximately midway between the eyebrow and the hair line at the peak of the brow. This relaxes the muscle that pulls up on the tail of the eyebrow, thereby restoring a natural appearance.
If I had a patient with the concern described here I would first want to see before and after pictures to determine if she would be a good candidate for the correction described above.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!

Will the Spock eyebrow look lessen? My frown (11) has not changed yet but the vertical lines on my forehead have smoothed out.

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