Really depressed over severe Botox brow asymmetry (Photo)

Question

Im so upset. i had botox 5 weeks ago, within 3 days my eyebrows were severely uneven, one lost the arch, on the other the inner part descended a lot. I went back to my practitioner after 2 weeks she injected more but the problem seems worse. Im so self conscious i dont even want to walk down the street or go out. My question is do i go back again, or will a different practioner fix it for me. Or have i just got to suffer till it wears off? Bocouture was used but i dont know quantities injected

Nancy de Kleer, MD, FRCSC (Plast) · Answer

This is a disappointing outcome and I'm sorry to hear you have had this experience.I recommend obtaining a consultation from a Plastic Surgery or a Dermatology office with a great deal of experience with Botox.  You may obtain some improvement with a small dose to lift the R eyebrow, however it is not possible to be more specific than that without examining your face at rest and with movement.Your other option is to wait until the Botox wears off, which will occur 3-4 months following the treatment.Best of luck to you,Dr. Nancy de Kleer

Jonathan Kulbersh, MD · Answer

I'm sorry you're unhappy with your final results. Luckily, Botox results aren't permanent. Botox results resolve in 3-4 months. Hope this helps.

Alex Eshaghian, MD, PhD · Answer

Thank you for your question and for sharing your photograph kel321. 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 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.In addition to addressing various wrinkles, Botox can also be used to adjust the position and shape of the eyebrows. It works the same way as it does when addressing wrinkles, namely by relaxing muscles. In the upper forehead, there are muscles that move the eyebrows up and other muscles that move the eyebrows down. The muscle that moves the eyebrows up is on the upper forehead; this is called the frontalis muscle. It is responsible for the horizontal lines seen on the upper forehead when one raises the eyebrows. The muscles that pull down on the eyebrows are located between the eyebrows and at the corners of the eyebrows. The muscle group between the eyebrows is called the glabellar complex. There is another muscle that goes around the entire eye called the orbicularis oculi muscle. The portion of this muscle under the tail of the eyebrow is responsible for pulling down on the tail of the eyebrow. When any of these muscles is relaxes with Botox the position of the eyebrow can be adjusted. When treating the horizontal lines on the upper forehead seen when one raises the eyebrows, if the dose is too high or if the placement of the product is too low it can lead to the feeling of a heavy eyebrow, difficulty raising the eyebrow, or downward movement of the eyebrow. This can also lead to downward movement of the eyelids, making a person appear tired. It also can make it difficult to apply eye makeup. To correct this Botox is placed in the antagonistic muscles, those in the glabella and orbicularis oculi which pull down on the eyebrows. This will raise the position of the eyebrows. These two areas can be treated with Botox to provide a brow lift. To do so 4-20 units of Botox are used in the glabella between the eyebrows and 2-12 units of Botox per side are used at the tail of the brow and/or the entire crow’s feet region.When patients present with concerns about specific wrinkles in the upper face such as the frown lines, I always assess and usually treat the other wrinkles in the upper face including the horizontal forehead wrinkles and crow’s feet. The reason is to maintain a harmonious and natural balance to the appearance of the upper face. The muscles in the glabella which are responsible for the formation of the frown lines serve to pull down on the inner brows when a person frowns. Similarly, the muscles around the eyes which are responsible for the formation of the crow’s feet seen when smiling (orbicularis oculi) are also responsible for pulling down on the brows, but in this case the outer brows. On the other hand, the muscle in the upper forehead which is responsible for the formation of the horizontal forehead wrinkles when a person raises the brows (frontalis) serves to pull the brows upward. If one of these muscles is relaxed with Botox and the others are not, the other muscles will still be active. This will lead to an unbalanced and unnatural appearance of the upper face where the brow can be elevated, depressed, or uneven in shape or position. Therefore, I recommend that my patients take a global approach to the upper face when receiving Botox treatments and treat all three of these areas. Sometimes bunny lines on the bridge of the nose are also treated.If I had a patient who looked like the person in this photographs I would say that she may be a good candidate for correction with additional units depending on the dose, placement, and timing of the previous treatments.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 as described above. 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!

John J. Bandeian, MD · Answer

I am sorry that you got a poor result with Botox. I can't make any specific recommendations for your problem because the picture is not adequate.  Unfortunately, every Tom, Dick and Harry thinks he can increase his./her revenue with injectable treatments. If the practitioner understands the effect of eyebrow position changes with Botox, asymmetry can usually be avoided or treated with small touch ups of Botox. I suggest that you go to a board certified plastic surgeon who has considerable experience with Botox/Dysport and see if he/she can help correct the problem.

Richard Brighton-Knight, MBChB · Answer

Botulinum toxin (which ever brand) will wear off at about 3 months. Often with the (hopefully) smaller doses above the eyebrow it can start to wear of sooner.
Another Doctor may be able to find a bit of lift to the eyebrow, but this may not be possible now that you've been injected twice. You may need to wait until it wears off. I would encourage you to keep moving the forehead and trying to lift the eyebrow, as this may encourage the Botulinum toxin to wear off sooner.
Kind regards

Really depressed over severe Botox brow asymmetry (Photo)

Answers (5)

Answer: Need better pictures

Answer: Need better pictures

Answer: Another Doctor may or may not be able to help

Answer: Another Doctor may or may not be able to help

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.

Really depressed over severe Botox brow asymmetry (Photo)

Answers (5)

Answer: Need better pictures

Answer: Need better pictures

Answer: Another Doctor may or may not be able to help

Answer: Another Doctor may or may not be able to help

Browse related questions

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.