One eyebrow raising much higher than the other after Botox. Is this normal?

Typically one can start seeing results from Botox in 3-5 days.  Full effects are usually visible within 7-10 days.  It is possible that one side is showing Botox effects faster than the other side. It's also possible that there will be some asymmetry even a few weeks or months after injection, but I always recommend waiting the full 10 days after injections before deciding on touch ups as results can still change up to around that point in time.  I would also advise speaking with your expert injector about any concerns you might have.All the best,

Sometimes there is some asymmetry in the eyebrows following Botox injections.  You should make an appointment with your doctor to discuss your concerns.  It is possible that the issue can be fixed with a simple Botox touch up.

Thank you for sharing your excellent question.  Though I would allow a full two weeks to pass before seeking additional treatment, a small amount of carefully placed Botox above the "higher" brow should help correct the "Spock-like" condition.  Hope this helps.

Thank you for your question. Botox can take up to 2 weeks to take full effect. If you are still experiencing the "spock look" after 2 weeks, I would call your physician for an in person follow up. Often this can be corrected with a couple additional units of botox. If you choose not that do that, then it will not get worse, and it will wear off with time, about 3-4 months.

Hi,Thank you for your question. While it's difficult to say without photos, it sounds like you may have some residual muscle activity at the lateral brow. One of two things may be happening:1) Botox takes 2 weeks for the full effect. The "spock brow" may continue to resolve on its own with time but scenario is less likely as one brow is not moving and the other is, suggesting that one brow elevator is either under-treated or you have a hyperactive muscle on that side. The spock brow most likely will not get worse with time- it just won't get better. I would encourage you to follow up with your injector at 2 weeks to reevaluate.2) Your injector did not treat laterally enough on one side of the forehead (the side with spock brow). This is an easy fix and typically only requires 1-2U to relax the frontalis muscle for better symmetry on animation.Hope this helps!

Thank you for your question hgeorge1. 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.If I had a patient with the concern described here I would likely recommend a small amount of Botox on the upper forehead above the eyebrow that is higher. This will relax the muscle that is pulling the brow upward and provide a natural appearance. I would also recommend taking a global approach as described above at the next treatment.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!

Hi hgeorge1,

 Thank you for your question.
“Spock brow” can occur when Botox is placed centrally in the forehead limiting the movement here, but not placed far enough laterally. This can leave too much movement on the sides of the forehead, allowing those muscles to pull the tail of your eyebrows upward
This can normally be easily fixed with a small amount of Botox placed to the lateral sides of the forehead, relaxing that muscle so it isn’t pulling the eyebrow tails upward.

 I’ve created a video where I review Botox and how it functions.
I hope this information helps in our research!

This type of asymmetry is corrected quite simply with a touch up of Botox.  I recommend waiting for two weeks in between injections.  See your injector for an evaluation.

Thank you for your question. Sometimes one brow can pull harder than the other. Not to worry, it can sometimes resolve itself. However, give it time to do so, at minimum 2 weeks. If there is no self correction then follow up with your injector at 2 weeks to discuss any questions or concerns that you may have. Results from these treatments are visible within 3-7 days with results that can last anywhere from 3-4 months. Hope this helps. 

Thank you for your question. You can either have the one side drop or have the other side raise. Your injector should be able to fix it. This happens from time to time even with the best injector. All the best, Dr. Thuy Doan. ATL.