Medial Brow Droop and Overarched Brow from Botox, What Can I do?

I had my first Botox treatment 5 days ago in the frontalis (conservatively) and procerus, for horizontal forehead lines. When I raise my brows, the medial brows droop while the arches go high up, creating an angry look. The area over my middle brow looks puffy when arching. I also have a chronic headache and heaviness between and above between the brows, along with a constant pulling feeling above the arches. Is there a way to correct this? I am going for my follow up next week. What can I do?

Doctor Answers 10

Medial Brow Droop and Overarched Brow from Botox...

Your medial brow droop is likely due to relatively overactive Corrugator muscles that are still depressing the medial (inside) aspect of your brow -- they will likely just need a Botox "touch-up".

Your high arches may be due to either lack of Botox to the lateral (outside) Frontalis muscle, or too much Botox to the lateral Orbicularis Oculi (top of Crow's feet).  Either way, a little Botox "touch-up" to the lateral aspect of your forehead should improve the arches.  This may also improve some of your headache if it is due to the "constant pulling feeling above the arches."

In the future, I would recommend seeking the services of an experienced physician injector. I think the key with Botox lies in truly understanding the anatomy of the injected area, and more importantly the variability in the anatomy between patients -- for brows, the forehead, and anywhere else you plan on receiving a Botox injection. This includes having a firm understanding of the origin, insertion, and action of each muscle that will be injected, the thickness of each muscle targeted, how deep beneath the skin the actual muscle resides, and the patient variability therein. As an aesthetic-trained plastic surgeon, I am intrinsically biased since I operate in the area for browlifts and facelifts, and have a unique perspective to the muscle anatomy since I commonly dissect under the skin, see the actual muscles themselves, and learn "first-hand" the incredible variability between patients -- live, "on the OR table" -- as opposed to via lectures or a cadaver dissection. For me, this helps guide where to inject and where not to. However, with that said, I know many non-aesthetic trained plastic surgeons and other physicians who know the anatomy well despite not operating in that area, and get good results.

Good luck.

Dr Markarian 

Overdone Botox

You might need a little Botox on the lateral forehead to depress the over-arching and more in the glabella and procerus region to weaken the depression there.

Julio Garcia, MD
Las Vegas Plastic Surgeon
4.8 out of 5 stars 27 reviews

Overached eyebrows from botox

This is easily corrected by injecting botox to the outer areas fibers of your forehead muscles. In the future inform you botox injectors of this incident and clarify that you do not want it to happen again. They should know to a void over injecting the outer fibers of the orbicularis occuli in tandem with the paralysis of the middle aspects of the forehead and glabella areas (area between the eye brows).

Sanusi Umar, MD
Redondo Beach Dermatologic Surgeon
4.6 out of 5 stars 32 reviews


Based on your description it sounds like you may need more Botox units on the outside of your forehead to relax the the brows further.  however, Botox takes about 2 weeks to see the final effect and i would not do any correction until that time because you run the risk of overcorrection. Please have your doctor evaluate. Dr. Halem

Monica Halem, MD
New York Dermatologic Surgeon
4.4 out of 5 stars 7 reviews

Modification of Botox for the forehead lines

yes, you may need more units of Botox injected to the outer forehead to relax this part of the frontalis muscle so it doesn't overcompensate and pull up too much on the outer eyebrows because it struggles to pull up on the middle forehead but can't. You might need more also, to miniimize the bulge you mention. See your doctor to reevaluate. I would encourage you to wait for two weeks so that the Botox has full effect and the result you have can be modified better.

Ronald Shelton, MD
Manhattan Dermatologic Surgeon
4.9 out of 5 stars 38 reviews

How to correct arched eyebrows after Botox

The details of your treatment plan are very thorough and help to address the potential problem.  For example, the fact that you received a conservative dose in the forehead but experienced very arched eyebrows is related to the lateral (sides) your forehead and above the eyebrows not receiving the proper attention.  Therefore, this part of the frontalis muscle will continue to pull or actually pull harder which causes the "Spock" look of the eyebrows.    If this does not soften over the next week, your practitioner can easily remedy this with a small touch up dose.

Being that only your procerus muscle was treated, all of the other facial muscles responsible for frowning are still in use which leads to a pulling down and inward of the inner (medial) eyebrows.  This, too, may be corrected by properly dosing additional muscles in this area.  

An experienced injector will know how to prevent these outcomes or, at the very least, remedy these unintended results by offering a touch up.  Understanding how facial muscles work independently and synergistically is vital in developing a natural and satisfying treatment outcome.

Regarding the feelings of heaviness, this too should improve as the proper muscles are treated and begin to relax in response to Botox.  

Be certain to have your practitioner address your concerns so that they may remedy the situation and retain you as a valued patient.



Harold J. Kaplan, MD
Los Angeles Facial Plastic Surgeon
4.4 out of 5 stars 7 reviews

Medial Brow Droop and Overarched Brow from Botox, What Can I do?

  The effects of the Botox will last about 3-4 months and if you do nothing, everything will return as it was before the Botox was injected.  If the medial brow droop is making your face look angry...a small amount of Botox can be used to lower the lateral section of the eyebrows softening this effect.  Be sure that the MD that does your Botox, Dysport or Xeomin injections understands and follows the proper aesthetics of facial beauty.

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.6 out of 5 stars 25 reviews

You have had an unbalanced botox service.

By analyzing how the face is pulling, yes it is possible to treatment this situation with additional BOTOX to help with the overall facial balance.  Steve Fagien in Boca Raton is a Botox expert who can help you with this.

Kenneth D. Steinsapir, MD
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

Results from Botox treatments

Hey Wes!

Well to start it is a little early to see the final results it takes 10 days but I would give it two weeks before doing anything. If the problem persists you need to see a board certified plastic surgeon or some one that is experienced with administering the neuromodulators (Botox, Dysport, Xeomin). The problem sound like not enough was injected at the glabella area so you are not getting enough medial brow elevation the secound problem is not enough spread of the Botox more laterally in the forehead and so over active muscles in that region are elevating your lateral brows!!! If it is only minimal lines right over the lateral brow you can place a few units right at the lines to correct that deformity. So the combination of these problems are creating that look!

Some thing you may want to look into in your area is some one that uses Ultherapy from Ulthera. That may give you the brow lift you are looking to achieve with a longer standing results between over one year to two years!

Good luck !

Correcting "Bad Botox"

One of the benefits of having your Botox done by a good Plastic surgeon or dermatologist is that they know facial anatomy and can produce the result you want while staying away from results you do not want. Another important benefit is he/ she will soon know how you will react to Botox / Xeomin and will customize the results to you. In your case, the arch can be gently lowered with a few units of Botox above its apex. Just ask your doctor to help you. 

Good Luck. 

Perer A Aldea, MD

Peter A. Aldea, MD
Memphis Plastic Surgeon
4.9 out of 5 stars 109 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.