Botox: Too much? Or am I sensitive?

Question

I had Botox two weeks ago, crows feet, between eyes, forehead, and brow. One brow sits heavily over my eye, I can't lift it at all. My forehead does not move, has constant heavy pressure, and I have a headache between the eyes that feels like a Charlie horse. I called when the right brow dropped. He added more Botox in the brow. When I asked "why" he didn't give me a good explanation. Am I more sensitive than average or did he over inject? Is the headache from Botox? Help!

Rajat Gupta, MD, MS, DNB · Answer

It maybe both. I can not comment without seeing your records that state the units used and at what points. Usually it doesn’t happen, as Botox if done correctly doesn’t take off your expressions, it just takes off the extra expressions that you don’t want. Consult the surgeon who did your procedure and know about your history.

Martin Jugenburg, MD · Answer

It sounds like too much botox and poor placement were to blame for the pressure and heaviness to your brows.

Kenneth D. Steinsapir, MD · Answer

It sounds very much like to got too much botox.  I always encourage patients to start with a lower dose the first time.  One can always do more.  Why pay for more than you need.  I also perform a patented technique I invented called the Microdroplet lIft that lifts the eyebrows, relaxes the resting brow pinch without freezing the forehead.  This will wear off but it can take months.

Kerry Owens, MD · Answer

I am sorry to hear about your experience.  It is hard to know exactly the cause without knowing the dose used and seeing photos, but it does sound as if you have had too much Botox in the forehead area.  Sometimes this is a "sensitivity" to a dose used, or more likely you just got too much at once. With the first treatment you may in fact be more sensitive to the sensation of heaviness, but if you truly can't raise your brow the dose was too high for you. Unfortunately Botox isn't really reversible and must wear off on its own; the good news is that it does wear off and usually the degree of heaviness you are experiencing lets up more quickly as the effect diminishes and rather than the full 3-4 months may only take 4-6 weeks to get better.  I usually try to use as small a dose as I think will create the result a patient desires, as you can always add more if needed. Any experienced doctor should be happy to offer an explanation when asked; seek the opinion of an expert for any future treatments.

Lillian Overman, MD · Answer

it sounds like you have brow droop due to Botox. The good news is that it isn't permanent.
Factors that can make this more likely to happen are:
1. Botox being injected close to the brow
2. A higher number of units of Botos being injected
3. A personal tendency to droop.
Many of the patients who experience droop have the following characteristics:
1. Prolapse (drop) of the fat pad that starts off positioned under the brow in youth
2. An unconscious habit to lift the brows to get the fat pad off of the upper lid in order to improve the peripheral vision in the upward direction
3. A forehead that has grown very strong by being frequently used to lift prolapsed fat pads out of the visual field. Heavy forehead lines are often a tip off that a patient is over-using the forehead muscle to clear the upper visual field.
I have dealt with this challenging problems the following way:
1. Inject the Botox further up from the brow
2. Inject fewer units of Botox over the brow
3. Explaining to patients that they will have more residual forehead wrinkles if we do #1 and #2 to avoid droop.
4. For those patients in whom prolapse of the brow fat pad is playing a role, I suggest that they consider an off label use of Latisse to shrink their fat, a so called "chemical blepharoplasty". After a couple months of use, we can often be a little bit more aggressive in treating the forehead lines because, although the droop will still occur, it doesn't impinge on the upper eye as much and so is not as cosmetically objectionable.
Best of luck to you.

Jason Emer, MD · Answer

This is difficult to answer without pictures. Botox can sometimes cause a drooping or heavy brow. Venus legacy or thermage treatments may help soften results. If you're headache persists, I recommend following up with your Doctor. See an expert. Best, Dr. Emer

Francis Johns, MD · Answer

Thank you for your question.Is this the first time you had it done? The end result of Botox is not being able to move the muscle that was injected. Without seeing photos, it is hard to determine what kind of result you received. If you are unhappy, I would recommend getting a second opinion on it. Good luck.

Mitchell Chasin, MD · Answer

Injecting Botox properly requires more skill than people tend to think. It’s not as simple as going after the muscles that are causing wrinkles to form. The skilled injector knows too much Botox to the frontalis muscle (central forehead) can drop the brow, because that muscle is responsible for lifting the brows, and for creating those horizontal lines across the forehead. Typically, you want to balance the amount given to that muscle, and the amount given to the glabella (area between the brows, creator of “11s”) so that you are not “freezing” either of these muscles, but rather balancing their strength so they are both relaxed, but the brows are either slightly lifted or at the very least not dropped. This is similar to the idea of feathering a clutch in a manual transmission car – there’s a sweet spot, but you have to learn how to get there with experience and finesse
The fact that your muscle between your brows has seized up in a Charlie horse and is giving you a headache tells me this muscle is working overtime to try to compensate for your forehead muscle that has been knocked out. This suggests you were given too much Botox in the forehead muscle and not enough in the glabella. Even an experienced injector can do this when they are injecting a patient they’ve never treated before, because everyone’s muscles react a little differently. Typically, this is why experienced injectors go light on their first treatment of a new patient, and ask the patient to come back in 2 weeks for a touch-up. That 2 week window gives the Botox time to kick-in, so the injector can fine-tune the results at the follow-up appointment. Once you’ve established the proper dosing, it gets easier to retreat with accuracy and ease.
  
Were you my patient and you returned with the forehead completely knocked out, I would have injected your brow to try to balance out the muscles, just as it sounds like he/she did. It sounds like your doctor did what any skilled injector would have to try to balance things out at the follow-up. Did they possibly inject a little heavy-handed to begin with? Maybe. Are you more sensitive to Botox than the average person? Maybe. I would let them know that you wanted more of an explanation at your next visit, but from what you’ve detailed, I would trust that they are following the standard of care and are indeed much more knowledgeable than a lot of injectors out there.
  
If your headaches are persistent, I would call your doctor and possibly see your general practitioner as well.

Michael H. Gold, MD · Answer

Thanks for the question and sorry that you are having these concerns after your Botox injections.  There is really no-one out there that is sensitive to Botox although we hear that on a regular basis.  Sometimes not enough toxin is injected and sometimes, as seems likely in your case, too much toxin was injected.  The saving grace here is that things will improve over time and things will revert back to normal.  It seems that finding an expert injector is needed for you – so find a board certified derm or plastic and get things done correctly.

Jennifer Rullan, MD · Answer

Your description of a heavy eyebrow or the forehead not moving, is suggestive of possibly too much botox in the forehead (which means you use your forehead to lift your eyebrows) and/or movement of botox from the eyebrow area into the lower forehead.   If it is your first time, this doesn't mean this will always happen to you, it just means you will need a different injection amount and technique the next time.   In order to begin to feel better, I recommend you massage upward away from your eyes.  Move hands from eyebrow up to the top of your forehead a few times a day for a few minutes and this will help!  
 Good luck!

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