Brow ptosis after 4 units botox in frontalis and in orbicularis muscles. What can be done to treat this? (Photo)

Question

For the purpose of brow lift of my right eyebrow (i have asymmetry and the right eyebrow is lower), I got botox treatment in the following zones: frontalis and orbicularis muscl. After the 3rd day my eye got heavy and very hooded, agging eyelid.Now, it is 10th day and my look gets worse and worse. I think botox was badly injected,called my practitioner but she refused to put more botox. I think she was afraid not to make things worse.Could you advise me what ask for?Can't live this way 3 m.

Cory Bovenzi, MD · Answer

Hi and thanks for your question!I do see the left brow remains higher. If you are looking for more symmetry I would recommend more botox above the left brow in the frontalis. I would wait a full 2 weeks before a touch up though so the previous injection can be at full effect.

Alan Gonzalez, MD, FACS · Answer

Hello @Philosophical647346, Thank you for your question. I suggest you wait until the effects of the botox wears off. Botox effect is not permanent, it takes 3 months approximately for botox effects start disappearing. Keep in mind that the characteristics of the facial expression are directly related to the application technique. For more information and recommendations, it is best to consult with one or several board certified plastic surgeons. Best wishes! Alan Gonzalez MD, FACS.

Walter Joseph, MD · Answer

Hello! Dr. Joseph here from Beverly Hills, CA! Typically to perform a "browlift" with any neurotoxin/Botox, the Orbicularis Oculi muscle in the lateral brow area/lateral canthus of the eye can be injected, which decreases the brow-lowering action of the Orbicularis, and therefore the Botox allows the lateral brow to raise due to the native action of the Frontalis. This creates the "browlift" effect. As such, in your situation, I would recommend AGAINST Botox in the right Frontalis over the lateral brow. Botox in this area would DROP the right brow, and somewhat defeat the purpose of the Botox in the Orbicularis.In general, I advise my patients to wait a 2 full weeks before any "touch-ups" or corrections with more product. Over this time, the facial musculature can acclimate and "settle", creating a more desired result. However, if you still feel your R lateral brow is heavy and low, I would recommend one of the following:
-A few extra units of Botox injected into the R orbicularis oculi to further "lift" the lateral brow, OR...-A few extra units of Botox injected into the L lateral frontalis to lower to the L lateral brow just a bit for symmetry
I hope this helps! Feel free to reach out with any further questions!

Jessica Walker, MD · Answer

There is brow ptosis and lid ptosis and it appears you have some brow ptosis, which is common and often not considered a complication of botox, as botox is used to decrease the movement of the brow elevator, the frontalis. More botox could only make this worse. Unfortunately the easiest thing is watchful waiting as botox usually wears off around 3-4 months, and in some even sooner. For any future injections, make sure you are evaluated by a board eligible/board certified plastic surgeon to express your concerns about your brow asymmetry and you can come up with a plan together.

Mark Godley, MBChB · Answer

you can get temporary symptomatic relief using eye drops, (Alpha Agonist). Try obtaining some Upneeq.

Camille Cash, MD · Answer

I'm sorry you are having issues from your Botox treatment.  The effects of the Botox should gradually improve in the coming weeks.  If you are uncomfortable with your injector, you may wish to visit another injector for a second opinion.

Darryl J. Blinski, MD · Answer

Only way to improve the lifted side is very low dose of Botox to that side 1.5 cm above the eyebrow. Maybe may need 2 sessions about 2 weeks apart. Fee $500. Best to virtual consult with...

Thomas G. Korkos, MD · Answer

Hello!
While the matter should resolve itself in about 20-25 days, I understand it can be frustrating. Additional Botox can help some patients though that's generally not the route we prefer because it can agitate the situation. I would suggest asking your provider about eyedrops to help. Typically we have prescribed iopidine but there is a new product on the market, upneeq, that many providers are trying and may provide more immediate relief. 
Best of luck!Dr. Tom Korkos

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