I had vertical lines on my forehead done with Botox and the 11s . The result was evil eyebrow look. I want to try again (Photo)

The 11's never actually worked. The verticle did but they are not bad and I am not too bothered about them. I want to know which of these 2 areas was the culprit for the drooping brows? I have noticed some celebrities with the same look, is it just a side effect? I hate the 11's so much. Looking at me what else in fillers would you suggest?

Doctor Answers 10

Botox and Glabella

It sounds like you simply need a little Botox in the forehead to counter act the Botox in the glabella which should be easily accomplished in your follow-up. Best, Dr. Green

Evil, peaked eyebrows following Botox

Dear Carolbratton:

Muscles in the face for facial expression start at the bone and pull on the skin while those on the rest of the skeleton start on a bone and pull another bone across a joint for motion.

Those muscles used for facial expression are weaved in such a way that different muscles may come together to create different appearances even in the same area such as those between and over the brow. 

Botox is an injectible muscle relaxer. The results are determined by relaxing those muscle fibers injected. The evil, peaked appearance of your brow following Botox is due to your unique distribution and weave. 

After allowing the full onset of Botox, at 10-14 days, return to your injector for a easy "tweak" of Botox into the frontalis muscle just over the peak and the arch will gently round-out.

The corregator muscle is the primary muscle to create the inter-brow number "11" crease(s). When these muscles are paralyzed, a second muscle around the eye called the orbicularis oculi muscle is recruited by your brain to create this similar expression. Options to diminish the crease line include:
Botox of the orbicularis fibers creating the recruitment response,
Filler in the "11's" to resist the recruitment of skin by the orbicularis.

These techniques are for the skilled and talented. Find a Board Certified, well experienced Plastic Surgeon, ENT Facial Surgeon or Dermatologist to provide this level of injectables. 

I hope this has been helpful. All the best!

Dean P. Kane, MD, FACS
Baltimore Plastic Surgeon
4.8 out of 5 stars 70 reviews

A little touch up is needed

I recommend that you go back and see your doctor and get a little touch up of your Botox that will gently relax your eyebrows into a normal position. It is an easy fix. It is fairly common that people want an "eyebrow lift" and request the result that you have; just explain to your doctor that you want a little more natural look. It is also somewhat of a challenge to get the right amount of lift vs droop; but too high is easier to fix than droop so you are in good shape!
Dr. Quenby Erickson

Evil eyebrow look after Botox

Hello Carolbratton,

In patients with an expressive forehead who receive an injection in a V fashion in the area of the 11's it can lead to the evil eyebrow look (Mephisto look) that you are talking about.  Prevention with different injection techniques is nice but since you have it you can receive a few touch up injections on the outside of the forehead area to improve it.  In the photo your hair is covering the 11s which makes it difficult to comment on suggestions.  You need to be careful with fillers in that area as it is a high risk area for complications.  Resurfacing procedures and a few surgical procedures can be of benefit to improve that area.  

I hope this helps and good luck.  

William Marshall Guy, MD
The Woodlands Facial Plastic Surgeon
5.0 out of 5 stars 25 reviews

You need a touch up

I would suggest seeing your injector for a touchup.  You likely need some Botox in the forehead laterally (on the outside), to drop the outer brow so it is not peaking so much.  Next time they should also give more Botox in the corrugators medially and a little less in the forehead in the middle.  This should give your eyebrows a more aesthetic look

Brow position after Botox

Based on the single picture you've posted, I believe there are a couple of things going on. First, the Botox on the upper forehead was not carried out far enough lateral and left a sharp peak of the lateral brows. The next problem is that your medial (close to nose) portion of the brows is droopy due to over injection or too lateral placement of Botox in glabellar injection for treatment of your heavy vertical lines (11's). This is all due to injector technique and can easily be avoided in the future.

Edwin Ishoo, MD
Cambridge Facial Plastic Surgeon
4.4 out of 5 stars 20 reviews

Achieving natural results with Botox

Treating the vertical "11" lines alone will not cause drooping of your brows or a strange appearance Mephisto/Spock-like appearance.  Treating the forehead (frontalis muscle) in an excessive V-pattern during treatment will cause this appearance.  Your injector should be able to alter his/her technique to create a more natural appearance. 

Donald B. Yoo, MD
Beverly Hills Facial Plastic Surgeon
5.0 out of 5 stars 46 reviews

Botox and brows

The overly droopy or overly arched brow after Botox typically results from treatment of the forehead--the muscles responsible for the horizontal forehead lines.  These are brow lifters, and are a separate group of muscles from those between the brows, or the muscles responsible for the so-called 11 lines.  
Because Botox works in a dose-dependent manner, you may do better with a slightly lesser dose of forehead Botox in the future.  In the meantime, your best bet is to return to your treating injector to discuss your concerns.  Your injector may feel that touch-up treatment is appropriate after examining you, and will note your results for a modified plan in the future.  Good luck!

Inessa Fishman, MD
Atlanta Facial Plastic Surgeon
5.0 out of 5 stars 1 review

Evil eye look with Botox

This is known as the Mephisto effect because it looks like the devil. It is due to the fact that the injector did not go lateral enough on the forehead. to correct it is easy if the injections are carried out all the way to the edges--one of the issues is that one of the manyfacturers trains doctors incorrectly in this area and this is the result

Melvin Elson, MD
Nashville Dermatologist
5.0 out of 5 stars 6 reviews

Evil eyebrow look

Botox is a wonderful medication that has revolutionized the treatment of for it wrinkles. However, it is not perfect. If you have deep 11 lines Botox may not be able to get rid of them completely. There is also an art and also a science to determining placement of Botox and dosages. A little too much Botox in the lower forehead above the eyebrows especially the inside part of the eyebrows can cause some drooping there and give one a slanted eyebrow that some call Botox brow. Your plastic surgeon may wish to alter the dosage and placement location.

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.