Glabella looks very prominent after Botox. Middle brow crease after Botox. Can this be fixed? (photos)

Question

I had Botox for the 1st time 6 wks ago.The doctor injected 3 areas-forehead,glabella,smile lines.After about 2 wks I have noticed that my middle brow become very prominent ,heavy and there is like a dent, fold on my right side .I feel like I am forced to frown and look constantly angry.Went back to see the doctor and he said that my glabella muscles are very strong and injected more botox.2 weeks after second visit and I look like that. What went wrong and could it be fixed ?

Douglas Wu, MD · Answer

Thanks for the question and photos. Unfortunately, it is difficult to assess your concern based on a couple of images after treatment. I can tell you that precise placement of Botox injections is essential to produce an optimal result. If you had your original treatment more than six weeks ago, it is likely the effects will be wearing off within the next month or two. At that point, I encourage you to seek an in-person consultation with a board-certified dermatologist that can assess your specific needs and goals and then personalize your treatment to help you meet them.

Michael I. Echavez, MD · Answer

An examination of you would be helpful to give you the best advice, but if your frown muscles are relaxed from the Botox, I would consider adding a filler to fill in the furrow that you have.  I would discuss this possible option with the physician who treated you.

Alex Eshaghian, MD, PhD · Answer

Thank you for your question and for sharing your photographs nadeto. I understand your concern. Botox is a purified protein used to address wrinkles associated with facial expression. When injected into the skin Botox will relax the muscles and smoothen out the overlying wrinkles. The most common areas of treatment are in the upper face. These include the horizontal lines seen on the upper forehead when one raises the brows, the vertical lines seen between the brows when one frowns (frown lines), and the crow's feet seen around the eyes when one smiles.
It is difficult to make an assessment in the absence of consistent photographs before and after in the same lighting and angles for comparison. However, I hope the information provided here is useful.The appearance of frown lines is variable from person to person. Usually they are in a vertical orientation but sometimes they can be oblique and sometimes a horizontal line is seen across the upper portion of the nasal bridge. The most common variation is to have two parallel lines, hence the common term "11's" to describe them. But some people have one, three, or more lines. Some people also will see a bulge in the area when contracting the muscle. This bulge is smoothened out after a Botox treatment.
  
The pivotal studies used 20 units of Botox in the glabella area between the brow to address the frown lines, 24 units of Botox (12 units per side) to address the crow’s feet, and 20 units of Botox in the forehead area above the brows to address the horizontal lines seen when one raises the brows. These studies demonstrated that the peak results are seen 14 days after the treatment and most people enjoy their results for 3-4 months. At that point, a maintenance treatment is recommended. While some people start to see results as early as the next day, it can take two weeks for full results so patience is important. We have our patients return two weeks after their treatment to assess their results via photographs. At that time additional units may be added if necessary.
Although 20 units is a good standard dose to start with, some people require a higher dose because of higher muscle volume. This is common in mature patients, in those with large bulges from expressive faces, and in men. I find that Botox still works in these cases, just a higher dose is required. I have used up to 40 units in the glabella.If I had a patient with the concern described here I would want to see consistent pictures of her frowning before and after the treatment and the dose and placement of the product. I suspect a higher dose may be required and additional units may be of benefit.With any injection, there are risks such as pain, bleeding, bruising, redness, swelling, tenderness, and infection. We take special precautions to minimize these risks such as using a painless technique. We also treat bruises with a laser as early as the next day. Bruises usually resolve within two weeks if untreated. After a laser treatment bruises usually resolve in 1-3 days, but may still take two weeks for full resolution. In addition to these risks, with Botox there is also a risk that the product spreads or diffuses to nearby structures. Spread to nearby muscles can lead to side effects such as the temporary appearance of droopy eyelids or a temporary asymmetric smile.
  
After a Botox treatment, I recommend that my patients avoid heat exposure, alcohol consumption, and strenuous exercise for 24 hours and not lie down flat for four hours. This is because all of these activities may possibly lead to the movement of the product and consequent side effects such as droopy eyelids. Although there have been no definitive studies shown that these actually occur and some physicians do not provide such aftercare instructions, in the absence of data I err on the side of caution and recommend that my patients avoid such activities.
  
Please consult with a doctor for specific recommendations. Good luck!

Sachit Shah, MD · Answer

Thanks for posting the pictures. I would like to have seen your before pictures. You may benefit from more Botox injection to the procerus muscle or some filler. 
I would need to see some dynamic movements first. 
Best Wishes

Stephen R. Weinman, MD · Answer

I would suggest seeking a second opinion and a second doctor. They may do a different injection technique or maybe inject entire forehead rather than just the Glabella.

Glabella looks very prominent after Botox. Middle brow crease after Botox. Can this be fixed? (photos)

Answers (7)

Answer: Prominent Glabella post Botox injections

Answer: Prominent Glabella post Botox injections

Answer: Possibly

Answer: Possibly

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Glabella looks very prominent after Botox. Middle brow crease after Botox. Can this be fixed? (photos)

Answers (7)

Answer: Prominent Glabella post Botox injections

Answer: Prominent Glabella post Botox injections

Answer: Possibly

Answer: Possibly

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Recommended reading

Everything you need to know about Botox

Our mission is to create a world where every investment in modern beauty is Worth It.