How to best treat tension in right brow?

Question

Hi I carry a lot of tension in my forehead. I feel it over my right brow and lid and sometimes down right side of nose. It even looks like I am frowning slightly just on right side. It is uncomfortable and makes me look tired. From afar and in some lighting its is possible to see raised muscle on inner and outer side of right brow. I would love to have some relief from this tension but am anxious about treating one side of face. And also unsure if treatment would help at all. Many thanks.

Jonathan Kulbersh, MD · Answer

Thank you for your question. You may benefit from Botox Cosmetic treatments to relax the muscles in your face that are causing the feeling of tension you describe. This neuromodulator formula relaxes facial muscles by blocking the nerve signals that cause them to contract. I recommend that you schedule an in-person consultation with an experienced, board-certified facial plastic surgeon who can better assess your needs and help you decide on the best treatment plan for you.

Kristopher Day, MD, FACS · Answer

This is an interesting question. Sometimes botox, which is a nerve agent that decreases contraction of muscles, usually used in the face, can be used in a targeted fashion to create greater symmetry. In fact, if there is an asymmetry of nerve function after a trauma or surgery, then botox can be used on the other side to even things out.

Danielle Shanley, MD · Answer

This is a great question, I would recommend meeting with a skin care specialist before proceeding with any treatment. However, by the sound of it getting botox or dysport for the 11 area as well as the forehead may help with the tension your feeling by relaxing the muscles. Good luck!

George Yang, MD · Answer

Hi, the most commonly recommended solution to forehead tension is botox. In order, not to make your forehead movements assymetry, most likely the injector will inject both sides. Another option would be to inject your right side with a very light dose above the right outer brow to relax it, but not freeze the forehead completely. Having said that, botox only treats the symptom, but is not attempting to figure out and fix the problem that is causing you to raise your right eyebrow, but not your left eyebrow. I suspect that you may have assymetric eyes in relation to the amount of eyelid showing on each side. This assymetry may have been present for most of your life. The side that shows more eyelid is most likely your right side over time as we age, gain and lose weight (pregnancy), the fat around our eyes diminishes. This can cause hollowing or loss of fat above the eyelid, but under the eyebrow hairs. The skin under the eyebrow can get trapped because of the hollowing and reflexively you feel like raising that eye brow. The other side is fuller so you may not feel tension on your left side yet. If the left side also hollows, they it will become more symmetric, and typically botox is recommended for the entire forehead. If you do get botox the effects will be that your forehead relaxes and your eyebrows will come down to a relaxed position. However, for some this may cause a heaviness and you may notice a flap of skin develop above the right eyelid due to the forehead relaxing and no longer pulling the loose eyelid off the eyelid. Note that I didn’t say extra eyelid skin, just loose skin. The other diagnostic possibility that you may have along with the hollowing of the right brow/eyelid is blepharoptosis or ptosis of the eyelid AKA sleepy eyelid. It make one eye opening look smaller than the other side. If this is the case you would require further examination to see if you truly have ptosis or perhaps it is pseudoptosis. In my practice, instead of offering botox as a first line treatment to treat your symptom of right forehead tension, I look forward the cause and try to treat that first. If the cause is hollowing of the right brow and eyelid, I would treat the hollowing first. This often times fixes the problem and improves the eyelid symmetry. If the forehead tension is a new phenomenon for the patient, the filling of the hollow can relax the forehead. If they have had the hollowing and tension for a couple of years or more then this may now have become a habit and the filling alone will not fix the tension and some botox may be desired to further relax the forehead. The hope is that with the hollow filled the botox is being done to try to break the habit and long term try to wean the patient off the botox for this reason. They may like the smoothing effects of botox and want for continue for cosmetic reasons, but that is another discussion. Hope this provides some value to you. Good luck. best, Dr. Yang

Camille Cash, MD · Answer

From your description, Botox may be a solution to help lessen the tension you are experiencing in your forehead.  The treatment is done in the office and the final results are seen after 14 days.  The effects gradually wear off over three to four months.  I encourage you to visit with an expert injector to discuss your concerns and treatment further.

James Fernau, MD, FACS - Account Suspended · Answer

Hello, and thanks for your question. Botox paralyzes the muscles in your face, which will eliminate the tension in the muscle injected. Since there are no pictures posted, it is difficult to know whether it would be aesthetically pleasing to only get it injected on just one side of the face. Please see a board-certified surgeon for your consultation. Best of luck to you! 
Sincerely, James Fernau, MD FACS Aesthetic Surgery Certified, American Board of Plastic Surgery Certified, American Board of Otolaryngology/Head & Neck Surgery Member: American Society of Plastic Surgery (ASPS) American Society of Aesthetic Plastic Surgery (ASAPS) International Society of Aesthetic Plastic Surgery (ISAPS) American Academy of Facial Plastic Reconstructive Surgery (AAFPRS) American Academy of Otolaryngology/Head & Neck Surgery (AAOHNS) American Society for Laser Medicine and Surgery (ASLMS) The Rhinoplasty Society

Rita Rakus, MBBS - Account Suspended · Answer

Hello and thank you for your question. It is always best to see you face to face for a consult and examination however in this case botox would likely help if your issue is with muscle contraction - botox is simply a muscles relaxant so likely worth trying to see if it helps. I hope that helps answer your question. Always seek an experienced and qualified medical professional for these treatments. Very best wishes