Would Like to Understand Why Botox Brow Lift Went Wrong? (photo)

(Considering Trying Again in a Few Months with Different Injector) 5 weeks ago had Botox in frown area + small amount above lateral brows for a brow lift (see photo). Noticed slight lift in central forehead, but have difficulty raising eyebrows (especially outer sides), and outer part of brow became puffy/low. Went back, he added more above outer brow (see photo). This had no effect. Confused why this site is supposed to give a lift. Muscle anatomy indicates the outside frontalis would be here (or no muscle at all). My orbicularis oculi is still quite strong.

Doctor Answers 10

A Botox Brow Lift Requires A Great Degree of Finesse

Here is your anatomy lesson for the day. Lateral brow position is determined by the upwards pull of the Frontalis Muscle against the downward pull of the lateral Orbicularis muscle. Injection of a small amount of neuromodulater underneath the lateral brow is meant to selectively relax the Orbicularis muscle only . This gives the Frontalis a competitive advantage (it is now pulling up against a weakened Orbicularis), causing the lateral brow to lift upwards. It sounds as if the injection under your lateral brow not only weakened the Orbicularis, but also weakened part of the Frontalis muscle, negating the lift. Once both muscles have been weakened, adding more neuromodulator will not fix this issue. You will need to wait for the neuromodulator to wear off and try again. As you can see, this type of injection requires a good degree of finesse but typically works very well, Good luck.

Greenwood Village Facial Plastic Surgeon
4.4 out of 5 stars 26 reviews

Botox and brow lift

If your injector injected into the frontalis, rather than the lateral obicularis, you wouldn't get a "lift," but a slight droop, especially with too much product. It's not difficult to obtain (the lift) if the injection sites are precise.

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

Botox brow lift

The muscles where you were injected in the first picture actually fuction to both pull your eyebrows together AND down, so the lift effect is expected after injecting  (and weakening) this muscle group.  The injections above the lateral brow, however, WEAKEN the muscles that pull the outer brow up, so the first set of injections in this area cause the outer brow to descend, and the second set in this area could only create no improvement or make the effect more pronounced. Injections just UNDER the eyebrow can weaken the muscles that pull the eyebrows down and create some lift.

Bruce E. Genter, MD, FACS
Abington Plastic Surgeon
4.3 out of 5 stars 16 reviews

Would Like to Understand Why Botox Brow Lift Went Wrong?

 Injection of Botox, Dysport or Xeomin along/through the tail of the eyebrows and carefully massaged immediately after the injection so that the depressor muscles are weakened...allows the brow elevator muscles to craete a slight lift.

This should not be expected to create a lift comparable to a proper Browlift however, it can give an aestheically pleasing result.

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.6 out of 5 stars 25 reviews

How to Get Lateral Eye Brow Lift with Botox

Hi Sunny,

The lifting muscles (frontalis) and depressing muscles (corrugators, procerus, and orbicularis) oppose each other at rest.  To lift the lateral brow, the depressing muscles should be weakened with neuro-modulators Botox, Dysport, Xeomin (including the orbicularis), leaving the lateral frontal is alone, except for a very small dose to avoid the "Joker" arched eyebrow.  I am sure that you will let your physician injector know what happened, and it should be avoided in the future.  Good luck and be well.

Dr. P

Dr. P

Michael A. Persky, MD
Encino Facial Plastic Surgeon
4.8 out of 5 stars 36 reviews

Botox Brow Lift

You are correct about the anatomy.  The idea of a "Botox browlift" is to weaken the  muscles that pull the brow down.  These include the corrugators, the procerus, and the orbicularis.  The frontalis muscle moves the brow upward.  Any injections into the frontalis can potentially make the brow drop or feel heavy.  From your diagram, the injections placed over the eyebrows on the sides are clearly in the frontalis muscle, causing the effect you describe.  The injections on the sides need to be very close to the brow, or sometimes in or lateral to the brow, to affect only the orbicularis and not the frontalis.  It's also important that the injections between the brows be into the brow depressors only (staying low near the brow), to avoid affecting the frontalis.  You probably know more about the anatomy than many Botox injectors...

Matthew Bridges, MD
Richmond Facial Plastic Surgeon
5.0 out of 5 stars 24 reviews

Botox brow lift


This is a very good question. Botox works by temporarily weakening overactive muscles. When injected into the area between the eyebrows, two muscles which pull the brow downward are targeted, the procerus and corrugator muscles. Weakening muscles that pull the brow down helps produce a brow lift.

Botox injected ABOVE the lateral brow would affect the frontalis muscle, which pulls the brow upward. Weakening this muscle would produce the opposite effect, leading to a lower brow position.

To produce a lift of the brow, Botox should have been injected UNDER the lateral brow, weakening a portion of the orbicularis muscle, which pulls the brow downward. This injection site tends to produce a (mild) elevation of the outer brow.

Mitesh Kapadia, MD, PhD
Boston Oculoplastic Surgeon
5.0 out of 5 stars 167 reviews

The reason is that the wrong muscles are being treated.

Most so-called brow lift treatments are more designed to avoid causing eyelid ptosis and less concerned with brow lifting.  The orbicularis oculi at the eye brow and below the eyebrow functions as the eyebrow depressor.  Most so-called brow lift treatments actually avoids treating this muscle because it is widely thought it will risk dropping the eyelid.  I had the insight that these muscles insert into the skin.  By placing very small quantities of micro droplet botulinum toxin in very small quantities between the skin and these muscles, it is possible to trap the agent and limit diffusion, thereby avoiding upper eyelid ptosis.  I call this method micro droplet botulinum toxin treatment.  The insight was original and I have a US patent on the method.  This treatment is profoundly different than the method you have been getting.

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

Botox and brow lift

A chemical brow lift can occur when there is limited use in the lateral upper brow and injection performed along the orbicularis at the lateral eyebrow tail from below.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 29 reviews


I agree with your assessment.  You may want to find a new injector.  Make sure you see a board certified plastic surgeon or facial plastic surgeon with experience with Botox.



Asif Pirani, MD, FRCS(C)
Toronto Plastic Surgeon
5.0 out of 5 stars 35 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.