The most common problem when treating asymmetry with Botox is the creation of a new asymmetry.First, it is critical to understand exactly what the problem is.When patients have one brow that sits higher than the other, it's almost always the left side that sits higher.On closer examination of these patients, the entire eye socket will sit higher on the left then on the right.Next, an assessment needs to be made regarding the distance between the eyebrow and the upper lash line.If the distance between the brow and the upper lash line is the same on both sides, then raising one brow will create a new asymmetry because the distance between the brow and lash line will be different after treatment.Based on your picture, it appears that your brow simply is higher on your left than on your right, and your eye sockets are probably quite even.You have two choices. One is to gently lower the left brow. The other is to raise the right side.Lowering eyebrows tends to be highly undesirable, especially for women.Just remember if Botox is placed unevenly, you will have somewhat uneven facial expressions. If done very carefully, it is possible to raise the outer part of the brow, creating a more peaked look, but this has a limited effect on the inner brow.An attempt to raise both inner and outer brow on one side will create asymmetrical expressions.As previously stated, you need to go to someone who has true expertise in the field. I would start with very conservative treatments, maybe five units to start with, and try different areas over time.Another thing to consider is the normality of facial asymmetry.Everyone has facial asymmetry.If you search the Internet, there are several websites that show computer-generated symmetrical faces.These are done by creating one face using two lefts or two rights.When compared side to side, two things become obvious. First, the two faces look completely different. The face made of two left sides looks drastically different than the face made up of two right sides.Something else become striking. Both images look strange.The reason is is that you have never seen a symmetrical face. They simply don't exist. We are asymmetrical people both in regards to bodies and faces.Many times patients who are overly concerned over asymmetry should simply be reassured.In your case, I think we can see your asymmetry, but people other than yourself are probably not nearly as aware of it as you are.Best of luck,Mats Hagstrom, M.D.
