Drooping After Botox? Is 10 units enough to cause droopiness?

Short answer -- I would first wait 7-10 days to see the full effects of the Botox and return to your injecting physician for reassessment.A drooping eye-BROW may happen in the following scenarios:(1) When the brow-elevating muscle in the forehead, the Frontalis, receives too high a dose of Botox.(2) The Botox is sub-optimally placed too low in the forehead -- it should typically be placed at least 1 cm above the Brow. (3) Over-injection of the glabella area (between the brows). (4) It may also happen if you have a low set eyebrow to begin with, in which case any Botox to the Frontalis increases the likelihood of a brow droop. Ironically, a droopy eye-BROW from Botox can sometimes be improved with MORE Botox -- this time, the Botox is typically injected into the outside (top of the crow's feet) part of the eye (aka the lateral aspect of the orbicularis oculi muscle) to generate a bit of a brow lift in that area -- by injecting more Botox and paralyzing the orbicularis muscle that normally acts to depress the brow in that area, you may get a slight compensatory brow lift...If the extra Botox does not improve the brow droop, it will likely last as long as the full duration of the Botox -- 3-4 months.Please seek the services of an experienced physician injector. I think the key with Botox lies in truly understanding the anatomy of the injected area, and more importantly the variability in the anatomy between patients -- for brows, the forehead, and anywhere else you plan on receiving a Botox injection. This includes having a firm understanding of the origin, insertion, and action of each muscle that will be injected, the thickness of each muscle targeted, how deep beneath the skin the actual muscle resides, and the patient variability therein. As an aesthetic-trained plastic surgeon, I am intrinsically biased since I operate in the area for browlifts and facelifts, and have a unique perspective to the muscle anatomy since I commonly dissect under the skin, see the actual muscles themselves, and learn "first-hand" the incredible variability between patients -- live, "on the OR table" -- as opposed to via lectures or a cadaver dissection. For me, this helps guide where to inject and where not to. However, with that said, I know many non-aesthetic trained plastic surgeons and other physicians who know the anatomy well despite not operating in that area, and get good results.Good luck.Dr Markarian

Hi Anon.  It's very possible that your asymmetry, if it has come on after treatment, will fix itself over the next week and if it does not, could probably be remedied fairly easily after another visit.

As Dr. Prendeville pointed out, we often have patients present this same issue at their 2 week follow up and when we look at the before pictures they realize that a small imperfection that they think is new was actually pre-existing.  In any event, make sure to get back to you injector to review the issue.  Good luck.

It is not at all unusual to have early asymmetries after Botox the first few days. You should wait 10-14 days to see the final effect and then judge the result. I would advise you to have a two week follow up appointment with your injecting doctor to discuss your results.

Ten units of Botox is a very small/conservative dose over the forehead. Two days after your treatment is very early and the full effect will take about 2 weeks to be realized. Wait until that time and make a follow up appointment.

Good Luck!

Dr. C

johnconnorsmd.com

Regarding the drooping there are several factors to consider: 1) many patients have pre-existing asymmetries in brow p[position. If this is present, I point it out ahead of time so that the patient knows what to expect, 2) at 10 days, Botox has not reached its peak effect. I would re-evaluate the result in another week or two, 3) Botox treatment sometimes requires a little bit of titration or tweaking.  If you aren't happy in another week, go back and see your Dermatologist.

10 units of Botox is a relatively low dose for treating forehead lines.  My typical dosing for patients is 15-20 units.

Good Luck!