Do I Need a Top Up?

I had my usual botox dose for my forehead lines 2 weeks ago which was 4 injections, I have been having them for years with my doctor. This time it has worked well but one eyebrow is slightly higher than the other - not much but the whole treatment seems to have worked better on the left. He said I can come for a top up but would there not be a chance the uneveness could get worse?

Doctor Answers 14

Metaphisto brow after botox injections

The corragator muscle is interwoven with the frontalis muscle.  The corragator muscle creates the vertical glabellar creases and this muscle is a depressor of the inner aspect of the brow so this muscle will cause an elevation of the medial brow.  If the injection is performed too high or if the  Botox spreads superiorly then the frontalis muscle can be effected and this causes the brow to drop. Conversely if the central brow is injected and no botox is used laterally then you get a metaphisto or devil's brow.

Atlanta Plastic Surgeon
4.5 out of 5 stars 19 reviews

Touch up following Botox treatment

It is possible to even out your eyebrows with a touch up, and this is sometimes necessary to get the desired result from a Botox treatment. I would recommend discussing all potential complications with your physician who is performing the injections. I hope this helps, and I wish you the best of luck.

Paul S. Nassif, MD
Beverly Hills Facial Plastic Surgeon
4.7 out of 5 stars 47 reviews

Touch up after Botox

It does sound like another strategically placed injection could even out the asymmetry and improve the affects of the Botox.  It is commonly done and is perfectly fine if done at least 2 weeks after the initial Botox injections to allow the full effect to kick in.

Ritu Saini, MD
New York Dermatologic Surgeon
4.5 out of 5 stars 8 reviews

Botox forehead touchup

It is occasionally necessary to provide some touch up with Botox or Dysport to the forehead when there is an asymmetry in this region.  I would return to the doctor who performed the procedure and I am sure that we will correct the issue without making it worse.


Jacque P. LeBeau, MD
Pensacola Facial Plastic Surgeon
5.0 out of 5 stars 26 reviews

Brow Asymmetry after Botox

   The lifting of brows with Botox can be difficult to control, and a touchup with Botox can be in order to improve symmetry.

Kenneth B. Hughes, MD
Los Angeles Plastic Surgeon
4.9 out of 5 stars 492 reviews

Fixing minor asymmetry with a Botox "touch up"

While there is certainly a chance that the asymmetry may be worse, it's much more likely that a touch up will improve the symmetry.  

Donald B. Yoo, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 57 reviews

Botox touch up treatment

Even with experienced injectors, it is possible to get some slight asymmetry after a Botox treatment.  An experienced injector should be able to improve the mild unevenness that you had after your forehead was treated.  It definitely would be worthwhile to have the touch up done.  

Michael I. Echavez, MD
San Francisco Facial Plastic Surgeon
4.5 out of 5 stars 18 reviews

Botox and touch-up's

Assuming you mean "touch-up" I would follow up with the provider for better assessment and educate yourself on the effects and typical duration of Botox.

Sam Naficy, MD, FACS
Seattle Facial Plastic Surgeon
4.7 out of 5 stars 221 reviews

Be patient and return for eyebrow correction with Botox

As already recommended, wait 7-10 days and return for several units to be injected if there is residual asymmetry for eyebrow correction. it is very easy and should cost as little as 100 dollars.

Hratch Karamanoukian, MD, FACS
Buffalo Phlebologist
4.8 out of 5 stars 41 reviews

Botox for eyebrow symmetry

You should return to your doctor for assessment and treatment.  A small amount of Botox will help your forehead lines and make your eyebrows more symmetrical.

Martie Gidon, MD, FRCPC
Toronto Dermatologist
5.0 out of 5 stars 22 reviews

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.