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

Question

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?

Mark K. Markarian, MD, MSPH, FACS · Answer

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

Sanusi Umar, MD · Answer

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).

Ron Shelton, MD · Answer

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.

Harold J. Kaplan, MD · Answer

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.

Kenneth D. Steinsapir, MD · Answer

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.

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

Answers (9)

Answer: How to correct arched eyebrows after Botox

Answer: How to correct arched eyebrows after Botox

Answer: You have had an unbalanced botox service.

Answer: You have had an unbalanced botox service.

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.

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

Answers (9)

Answer: How to correct arched eyebrows after Botox

Answer: How to correct arched eyebrows after Botox

Answer: You have had an unbalanced botox service.

Answer: You have had an unbalanced botox service.

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.