I have lowered brow after dysport to forehead only. Can it be fixed? (photos)

Question

I got 50 units of dysport to my forehead and just a drop to the bunny line over my nose. I didn't have lines at my glabella nor at my crows feet so neither of those places were treated. This was 7 days ago and my forehead is super smooth. But now I have the Klingon/caveman look-my brows have lowered quite a bit. I can't decide if I look better or worse. My before pictures show more of an arch to my brows & more lid space. Will getting dysport at the glabella raise my brows at all?

Kenneth D. Steinsapir, MD · Answer

No he did not give you too much Dysport.  He did not use too much drug-the treatment paradigm is wrong.The problem here is that the typical cosmetic botulinum toxin treatment that doctors are taught to perform is all wrong aesthetically.  You are a perfect example of it and so are the crazy current pictures of Renee Zellweger.  The frontalis muscle is the main lifter of the eyebrows.  Directly injecting the forehead to reduce lines in the forehead will precisely do that.  The aesthetic price is a frozen forehead that drops the eyebrows like stones.  Yes the forehead is glass smooth.  But the forehead looks locked in and unnatural.  Also for you, you have slight upper eyelid ptosis.  Your brain compensates by lifting the eyebrows with the frontalis muscle.  After treatment you can't do this because the frontalis muscle has been knocked out.  Unfortunately this dropped brow crowds the orbital rim and makes you look pissed.  That is not the effect you want.  For a variety of reasons, we look older when the brows wad up like this at the orbital rim.It is improbably the your injecting physician will want to acknowledge this issue.  They get a bit defensive.  Generally they tend to think that they are divinely gifted to inject botulinum toxin and don't appreciate opposing views.I recommend that you carefully study my website regarding the Microdroplet botulinum toxin forehead lift methods that I developed.  The method is so unusual it was granted a United States Patent.  In my method, I leave the frontalis muscle alone.  I use many tiny microinjections close to the eyebrows.  This is where the muscles that pull the eyebrows down and make the brows pinch live.  This softens that brow pinch that makes you look pissed.  Because the brow depressors are weakened, the brow elevators (frontalis muscle) responsible for forehead lines don't have to work so hard to lift the forehead.  This means fewer forehead lines even though there is not direct frontalis muscle treatment.  The brows go up, the forehead lines are reduced, there is a softening of the brow pinch, and you are still able to move your head so no botox freeze and no klingon forehead.What to do about your current goofy treatment?  You could have a correctly treatment superimposed right now.  However, generally I think it is best to let the current treatment soft just a bit before doing this.  So ideally, you should have the correcting treatment in about 5 weeks.  If you can't stand things, yes, you could have the service before then with clinical benefit.  My full training video is available on vimeo on demand  if your are interested.

Barbara L. Persons, MD, FACS · Answer

One risk of dysport (Botox etc) in the forehead is that it can give you a heavy feel in the brow (Klingon/caveman as you humorously noted.)There's a technique to avoiding that...but sometimes it still happens. In these cases, I usually find that things definitely lighten up a bit (so if you are a week out, there's hope.) There are also tricks to "fix" your brows with more product. I usually offer free touch ups in these cases. Last, I always keep a good record of what I injected, and how, with all my patients. That record helps me perfect their treatments over time.

Soheila Rostami, MD, FAAO, FAACS · Answer

It appears that you usually hold your eyebrows up with using your forehead muscles. This can be a problem if neurotoxins are injected in the forehead, since it prevents you to lift your eyebrows.  You are not having eyebrow ptosis from the photos you have provided post injection. The eyebrows are at the level they should be without you lifting them. So I suggest not to get injected in the forehead or just very few units if you really have lines there.

Brian S. Biesman, MD · Answer

It is not surprising that your brows came down when the only muscle that elevates them was weakened.  Addition of neurotoxin to the brow depressors may help elevate the head of the brow.  I would seek the opinion of an expert injector in your area.

Inessa Fishman, MD · Answer

Treatment of the forehead lifting muscle (called the frontalis) with neuromodulator (Dysport, Botox, Xeomin) will result in its decreased function, and thus left lifting of the brow; when the brow/ forehead lifting muscle doesn't lift, it can't create the overlying horizontal forehead lines.  Depending on the dose used, the frontalis muscle may be slightly relaxed or nearly completely paralyzed.  Since the frontalis is the only lifter of the brow, weakening it leads to some brow lowering, which is dose-dependent.  One may get a bit of brow lift by treating the brow-depressing muscles between the brows (in the area called the glabella) and the tail of the brow.  When the Dysport wears off, your brow arch will return.  Discuss your concerns with your injecting provider, and consider using a smaller dose of Dysport for the forehead at your next treatment.

Stephen Weber MD, FACS · Answer

You can definitely see in your photos that your brows have dropped and your upper eyelids are more full. Thank you for posting photos. 50U of Dysport is a generous amount for the forehead alone. I will typically use about or even less than 1/2 that dose. At this point, very careful placement of Botox under the brow and between the brows can create elevation of your brow and improvement in the brow droop. Given the dose that you received the heaviness in your brows could last 1-2 months without additional treatment. I hope this information is helpful for you.Stephen Weber MD, FACSDenver Facial Plastic Surgeon

David Hartman, MD, FACS (license suspended) · Answer

Treating the muscles that cause the horizontal lines in the forehead doesn't cause the brow to "lift", but in fact, actually lowers the brow. The Frontalis muscle is the muscle the raises the brow and causes the "bunching" (wrinkling) of the skin in the forehead, ie., the horizontal lines. Treating the Frontalis muscle, softens the horizontal lines, but, also "lowers" the brow. It is the softening of the muscles that pull the brow down, ie., the muscles pulling "below" the brow: the Corrugator, the Depressor Supercilli, and the vertical segments of the Orbicularis Oculi muscles - that allow the brow to drift upward (lift) when they are weakened with Dysport/Botox. This may be confusing at first read, but, I hope it helps a bit.

I have lowered brow after dysport to forehead only. Can it be fixed? (photos)

Answers (7)

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