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
