Had Dysport Injected a Week Ago in my Forehead but my Eyebrows Got Raised in a Way I Have Permanent Wrinkles over Them? (photo)

Question

Can I get extra shots to correct this ugly looking? How many units of dysport should be used to treat the glabella and the forehead?

Barbara L. Persons, MD, FACS · Answer

First--to reassure--this will resolve as the effects of your treatment wear off. You won't get permanent wrinkles.

	 

	Some conservative treatment with botox/dyport can help with the appearance for now. Whenever I don't achieve the expected or ideal result with my patients, I do my best to fix the problem for free, and explain exactly what's going on. If you initially saw a plastic surgeon who you think is experienced, go back to her or him and they should be able to help improve the current look. If you get the sense this was due to injector inexperience, consult someone who can do better.

	 

	Dealing with complications--our own and those of other physicians-- is one of the more challenging parts of being a surgeon. It's also one of the most important.

	 

	Best and Happy New Year.

Robert F. Centeno, MD, FACS · Answer

The injection of neuro-modulators like dysport looks deceptively simple, but skill and techqnique are required to get an excellent result.  A good result means softening of your wrinkles, good balance of the muscles of facial expression so that you do not have a peaked brow, deeper isolated wrinkles, brow drooping, or eyelid drooping.  In your case, the frontalis muscle was overblocked centrally and not at all laterally making the lateral wrinkles more obvious.  A touch of dysport laterally will soften these lines.  You do not want them completely corrected as it will drop your eyebrows and make your eyes look tired.  Express your concerns to your injector and ask for correction.  Dysport is a great product in the hands of a skilled injector.

Stephen Bresnick, MD · Answer

Thank you for your question. It appears that quite a bit of Dysport was used to smooth your forehead. The only area which appears not to have been treated is the area above your outer eyebrow. When Dysport or Botox are injected into the forehead, the muscles in the area of injection are paralyzed. The outer brow tends to lift upwards giving a more dramatic arch. In your situation, your outer brow wrinkles can be softened with a tiny dose of Dysport into each brow area. Your doctor should consider a very tiny dose, because if too much is injected, your outer brows will fall. I would also suggest speaking to your doctor and see what he/she feels. Best wishes!

Jonathan Kulbersh, MD · Answer

Hello, and sorry to hear about the issue you experienced following Dysport treatment. In general, side effects from Dysport injections can include the following:
	
	1) Bruising
	2) Headaches
	3) Eyelid ptosis
	4) An expressionless appearance - (if too much is injected, or the injections are not performed properly)
	5) Minor swelling
	
	Duration and onset of side effects can vary from patient to patient, but generally will subside following a over a few weeks to months.

	In addition to these side effects, the brow can be elevated. You can have another treatment to help fix your issue. In your particular case, about 5 units of Dysport can help relax the brow to a normal position. It is important you choose an experienced injector for this, as you do not want the injections to be overdone. This may cause brow or eyelid ptosis to take place, and leave you with an entirely new problem. I hope this helps, and good luck to you!

Sam Naficy, MD, FACS · Answer

This can be a common occurrence with both Botox and Dysport.  Often times a conservative treatment just above the active areas can help to soften the area.

Tanveer Janjua, MD · Answer

Dysport is tricky to use close to the brow. The usual concern is the dropping down of the brow called 'brow ptosis' which does not look good and eye feel heavy. To avoid this situation doctors put the dyport higher up in the forehead but not close to the eyebrows. If a person is young then Dysport can be injected even close to the eyebrows.

	Typical dose for me is Glabella 60units, Forehead 60units. If I am concerned about eyebrows dropping down then I use only 30units in the forehead and spread it evenly.

	You need 10units of Dysport close to each brow and it will fix your problem.

	Best regards

	Dr. J

	Disclaimer: This answer is not intended to give a medical opinion and does not substitute for medical advice. The information presented in this posting is for patients’ education only. As always, I encourage you to see your personal physician for further evaluation of your individual case.

Donald B. Yoo, MD, FACS · Answer

It's not uncommon to have increased prominence of wrinkles directly above your eyebrows after Botox/Dysport, especially when you have a hyperactive frontalis muscle (muscle that raises your eyebrows). Your injector was careful to leave some movement of your eyebrows to avoid brow ptosis (droopiness). 2.5 - 5 u of Dysport injected at the peak of the wrinkles should improve the appearance of those wrinkles tremendously while maintaining an attractive brow position.

Matthew Bridges, MD, FACS · Answer

This effect is the result of weakening of the muscle that raises the brow in the center of your forehead without weakening the muscle over the outer part of you brow.  This can happen when injections intended to weaken frowner muscles between the eyebrows affect the brow raising muscle.  The only way to correct this now would be to inject a small amount of Dysport over the peak of your brow.  The only potential problem is that your brow will probably not move much at all after that.  Otherwise you have to wait it out...

	I typically put 50 units of Dysport between the eyebrows for the frowner muscles.  For the forehead above that, I typically use very small quantities, ie 20 units or so (6 or so units of Botox).

Aldo Guerra, MD · Answer

Thanks for sharing. I have seen this quite often and it should be evaluated by your injector - I'm sure they would appreciate seeing you. They may want to inject a few more units into the muscle that still moves (and causes these lines) - that should help. Best of luck, Dr. Aldo.

Kenneth D. Steinsapir, MD · Answer

Sofita

	Unfortunately doctors are fixated on paralysis as a sign that Dysport, Xeomin, or Botox is effective.  These treatments should never be about paralysis.  Weakening these muscles with these agents is a tool to adjust the balance of the muscles of facial expression.  Your treatment has over weakened the frontalis muscle in the upper half of the forehead.  The lower portion of the frontalis muscle is untreated.  This part of the muscle now must do all the lifting of the brow causing these muscle to overact and product the funny lines.  

	 

	The risk of asking for additional treatments is that your injector will most likely complete the forehead treatment.  This will eliminate the undesirable forehead recruitment lines.  The price will be compete paralysis of the forehead (think Marcia Cross on Desperate House Wives).  The treatment will now drop the eyebrows making the eyes look small and the forehead while line free will appear deadened.  An alternate approach is Microdroplet treatment of the brow depressors at the level of the eyebrow.  Finially, these lines are not permanent.  They will go away when the treatment wears off in a few months.  I would recommend finding an injector who can balance your treatment.

Had Dysport Injected a Week Ago in my Forehead but my Eyebrows Got Raised in a Way I Have Permanent Wrinkles over Them? (photo)

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