Is This Right? Had 50 Units of Botox, Arch Flattened?

I had 50 units of Botox FYI I am 29 and have been doing botox for 6 years, so I do not have any wrinkles. The dr injected the product up by my hairline and upper forehead, sides of upper nose, under eye and UNDER bow arch. I feel like my arch flattened a tat on one side.

Doctor Answers 5

Is This Right? Had 50 Units of Botox, Arch Flattened?

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Thanks for your question. Firstly I want to reassure you that the areas injected are appropriate areas to treat. To answer your question, we think of the brow muscles as either elevators or depressors of the brow. The reason I mention this is because paralyzing the muscles that normally elevate the brow can often cause the eyebrow to drop in position and possibly flatten. The converse is true for the brow depressors, where paralysis can cause an elevation of the brow. Think of it as a tug-of-war where the brow is the rope; if one team loses some players or has suddenly weaker players i.e is paralyzed so to speak, the other team will suddenly have a relatively stronger pull and the rope (or brow) will move towards that stronger team. What likely happened in your case is that the brow elevator on one side was paralyzed more than the other and the brow consequently dropped on that side and flattened. You have several options: The first would be to inject the elevators on the other side to have that other brow drop and achieve symmetry. The drawback is that it seems you do not like that brow position and would then have two brows in low positions that are undesirable to you. The second option is to paralyze the depressors on the side the brow is lower on. This will cause the brow to rise into a more appropriate position for you. It will unlikely make them completely even but that depends on the degree of asymmetry.The challenge is to know whether or not your depressors have already been maximally paralyzed in which case it would be futile to attempt this option. Your doctor would know that based on where she injected. The final option would be to wait for the botox to wear off. Although this may sound like a terrible solution, it is an option. Although botox is a safe and wonderful drug with so many therapeutic applications, it can sometimes be complicated. Good luck.

Columbus Facial Plastic Surgeon

Touch-up after Botox treatment

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The areas you describe are fairly routine treatment areas.  When properly placed, Botox under the lateral brow relaxes the lateral brow depressor (orbicularis) and helps to elevate the brow. The forehead injections above your brow arch are more likely to have caused the flattening. Upon follow up with your doctor he/she may inject a few more units into this area to help elevate your flattened brow. 

Donald B. Yoo, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 64 reviews

This is a very standard treatment that you received.

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Unfortunately it is also very thing that people to not like in a botox treatment.  To your doctor, it is an amazing service because after all, there are no forehead lines.  However the bad news is your forehead is paralyzed.  You have no forehead movement and the treatment makes you look locked in and inauthentic.  There is an alternative to this type of treatment called the Microdroplet botulinum toxin forehead lift.  It is a treatment I developed and it is so unique that it received a patent.  Instead of treating the entire forehead, my treatment is restricted to the eyebrow depressor muscles along the eyebrows.  The brows are softer, look more natural and the forehead is not frozen.  I am providing you a link to learn more about this treatment.

Kenneth D. Steinsapir, MD
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

Botox touch up

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You can always go back to your injector and get a Botox touch up to improve the flatness under your brow.

Jhonny Salomon, MD
Miami Plastic Surgeon

It's possible to drop a brow with Botox injection

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There are a number of different areas in which to inject Botox.  I do not see any photos of your brow posted, but even in the best hands, flattening can occur.  Although I do not typically inject under the brow arch, I have had other physicians whom I've injected and models ask me to inject in the brow itself because of their previous experience of being injected under the brow.

In the state of Nevada, we are not allowed to split a 50 unit bottle with multiple people, and although you may not need all 50 units, if they are not used, they will be disposed of since they are for single patient use.

As you know being an experienced Botox receiver, the effects will wear off in 4-6months, if you are experiencing any eyelid drooping, ask your provider about eye drops that can help.

H.L. Greenberg, MD
Las Vegas Dermatologic Surgeon
5.0 out of 5 stars 5 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.