EYEBROW Droop from Botox in Corrugator Muscle (Treating Frown Lines)...is It Possible?

Question

I had Botox 6 Days ago for frown lines (Standard 5 points of injection), with the two Corrugator injection points being just above either eyebrow. I notice now that my right eyebrow sits a little higher then the left. I am not sure whether the left has drooped slightly, or the right has raised slightly I know Eyelid droop is a possibility when having frown lines treated, but is EYEBROW droop also possible? I am worried the Botox was injected too close to my eyebrow. . When Botox is injected

Sonia Badreshia-Bansal, MD · Answer

Thank you for your question. It is possible to get drooping of the brows from Botox injection.  It is  best to follow up with your injector and compare your before picture so can determine the treatment plan.  I would also recommend being treated under the supervision of a Board Certified Dermatologist or Plastic Surgeon for safest and best treatment option. I hope this helps.

Mark K. Markarian, MD, MSPH, FACS · Answer

Yes, you can have both lid and brow droop from your injection.  It typically takes 7-10 days for the full effects of Botox to set in, so I would wait a few more days before seeing your injecting physician for an evaluation of any possible asymmetry.Eye-LID and eye-BROW droop can be caused by a number of reasons...A Droopy Eye-LIDA droopy upper eye-LID may occur if the Botox is injected too close to your eyelid-elevating muscle, the Levator Palpebra Superioris. In such a scenario, the Botox will diffuse inadvertently onto the Levator muscle and cause an eyelid droop. A lower dose typically diffuses onto the levator muscle and so the other good news is that the eyelid droop will typically NOT last as long as the full Botox duration of 3-4 months, and may in fact resolve in less than a month. Note, however, that if the eyelid droop occurred shortly after injection (i.e. within 3-4 days), then your eyelid levator muscle likely received a significant dose of Botox and your eyelid droop may not resolve for 1-2 months or more...On a side note, you may have an increased risk of eye-LID drooping if you have a weakened upper eyelid muscle for neurological reasons, or a deeply set eye-BROW that would be more prone to drooping and result in skin gathering over the eyelid making the eyelid appear like it was drooping. During your consultation, your injecting physician should rule out both of these scenarios to ensure you are an appropriate candidate for Botox... Your thyroid disease is not a contraindication to Botox or to the treatment of your eyelid droop, which brings me to my next point...A droopy upper eye-LID due to Botox can be treated with Apraclonidine (aka Iopidine) eye-drops. These eye-drops are commonly used to improve Gluacoma – a condition of high “eye ball pressure”. However, besides lowering the pressure in the eye, Apraclonidine causes the Muller muscle in the upper eyelid to contract and lift the upper eyelid about 2mm.The usual dose of Apraclonidine 0.5% is 1-2 drops, 3 times per day until the Botox wears off. (Note, make sure you put in one drop at a time, tilt your head back, and close your eyes to make sure none of the eye-drop leaks out.)   Apraclonidine should be used with caution in patients taking Beta-blocker eye drops (ex – Timolol), or certain pills for high blood pressure (such as Beta-blockers), Digoxin, and those taking MAO inhibitors (ex – Phenelzine) for Depression. Be sure your prescribing physician also discusses the potential side-effects of the drops, such as "adrenaline-like" symptoms like anxiety or heart pounding; you may also experience eye irritation, eye dryness, and eye pain, amongst other symptoms. If these symptoms occur, you will likely need to take some lubricating eye drops, lower the dose, switch the eye-drops, or stop the drops altogether...A Droopy Eye-BROWA 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) 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, as mentioned above, 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 (and even possibly restore some of your natural eyebrow arch)...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.When it comes to Botox, I would recommend seeking, at the very least, 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. So, what kind of physician should be injecting your Botox? 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 as 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

Steven J. Pearlman, MD, FACS · Answer

Botox works by relaxing muscles. The effect depends on the muscles and their orientation as well as the individual treatment. On some people the frown lines pull horizontally and on others diagonally. Also the forehead muscle called the frontalis may be affected by frown line injections as well. Note the changes and discuss with your doctor. The placement of Botox can be modified next time as they get to know your personal anatomy.

Richard Baxter, MD · Answer

The corrugator muscles and procerus (if you had injection in the midline) are brow depressors, so Botox would create some brow lifting not drooping. It may need to be adjusted if still asymmetrical after 2 weeks.

Sam Naficy, MD, FACS · Answer

I would suggest following up with your provider. It may be that you just need one side to settle down - and require a touch up where your lid is higher. Botox can take up to two weeks to set up so I'd follow up closer to the 2 week post treatment date. It's also possible that you do have eyelid ptosis (droop) and it would be beneficial for your provider to see so they don't repeat the same treatment in the future.

EYEBROW Droop from Botox in Corrugator Muscle (Treating Frown Lines)...is It Possible?

Answers (10)

Answer: Eyebrow droop not common with Botox

Answer: Eyebrow droop not common with Botox

Answer: Botox and eyelid ptosis

Answer: Botox and eyelid ptosis

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EYEBROW Droop from Botox in Corrugator Muscle (Treating Frown Lines)...is It Possible?

Answers (10)

Answer: Eyebrow droop not common with Botox

Answer: Eyebrow droop not common with Botox

Answer: Botox and eyelid ptosis

Answer: Botox and eyelid ptosis

Browse related questions

Recommended reading

Everything you need to know about Botox

Our mission is to create a world where every investment in modern beauty is Worth It.