Botox: eyes feel heavy, my eyebrows are different? (Photo)

Question

I got botox done in my forehead, looks good... except my eyebrow have lost (almost) their arch and my eyelids feel extremely heavy. It’s only been 12 days, but I have been getting really bad heacahes. Is this normal? Should I go back in? I look what my forehead looks like, it’s just the eyebrows. heavy eyelids. I’ve heard of people just getting eyebrows over the counter, but I’m not sure what to do . (before) (after)

Brock Ridenour, MD · Answer

It is not uncommon to experience headache and/or a sense of 'brow fatigue' after your first treatment with Botox.  The feeling generally lasts a couple of weeks and doesn't return with later treatments. If you have lost your brow arch, it may be that your dosage was too heavy.  Your frontalis muscle (forehead) is the only muscle that supports your brow and holds it up. You have other muscles that pull your brows downward, including the frown muscles (corrugator and procerus) and the muscles around the eye (orbicularis). These muscles are in a "tug of war" for your brow position and your doctor may need to weaken the "downward" pulling muscles to achieve better muscle balance and brow position. In the future, they can reduce your forehead dose to achieve an ideal result. Even if you do nothing, your forehead will "recover" just a little bit in the next couple weeks and your brow won't feel so heavy. My best to you.

Alan B. Brackup, MD, FACS · Answer

Thank you for your photos. Yes, your eyebrows have dropped and the left brow has especially flattened. You treated the frontalis muscle (which is the muscle that lifts the eyebrows-  when your raise your brows in the pre-photo- those are the lines you wanted to treat). So you will need to just have them treated with less product next time. I would also talk to your doctor about dysport. I really like dysport in the forehead for those horizontal lines. Hope this helps. Good news is that it will wear off.

Cameron Chesnut, MD, FAAD, FACMS · Answer

Eyelid drooping after neuromodulators like Botox, Dysport or Xeomin is a rare but well described issue, usually resulting from product placement or the amount used. 
The first thing that needs to be determined is whether it is a droopy eyebrow or truly a droopy eyelid. Droopy eyebrows are much more common and result from immobilizing the only muscle on the forehead that is able to lift up our eyebrows. Droopy eyelids come from the product getting into the wrong muscle that elevates the eyelid.
Management of them is quite different, but both have strategies to help expedite resolution while waiting for them to resolve with time, and any experience injector should be very familiar with how to deal with them: drops for the eyelids and precise placement of Botox in the brow depressors when it is an eyebrow issue. To ensure you are receiving the highest level of care, seek out a modernly trained, new-school dermatologic surgeon, oculoplastic surgeon, facial plastic surgeon or plastic surgeon who is board certified and fellowship trained in one of these “core four” cosmetic specialties. Membership in organizations like the American Academy of Facial Plastic and Reconstructive Surgery help to identify a highly trained surgeon.
Cameron Chesnut
#realself500 Physician

Aldo Guerra, MD · Answer

Thanks for sharing your story and photos. I am sorry about the heavy feeling and I think you should go and talk to your injector about your results. Since the Botox was only placed on the forehead muscles, the glabellar and orbital muscles are pulling down your eyebrows. I believe a small amount of Botox will relax these muscles allowing the eyebrows to move up a bit. Ask your injector for an assessment and see if they feel this approach for a mild "chemical brow lift" will benefit you.Good luck, Dr. ALDO

Sheryl D. Clark, MD, FAAD · Answer

Dear lynn3963:The muscle that pulls the eyebrows up (the frontalis) interdigitates with and opposes the complex of muscles that pull the eyebrows down. So, if you relax the muscle that pulls the brows up without also relaxing the muscles that pull them down, the brows will be pulled down.  This can be avoided by relaxing both sets of muscles, or by injecting the frontalis muscle very high above the brows.At this point, you can relax the brow depressors and the brows will lift, or you can wait several months (typically three unless a large dose of Botox has been used) for the effect to wear off.All the best,   Dr. Clark

Shaun Patel, MD · Answer

I suspect a little too high of a dose of Botox was used and it may have been placed a little too close to your eyebrows resulting in flattening of the left eyebrow and heaviness of both eyelids and forehead. Unfortunately, you will need to wait for some of the Botox to wear off. It can take 3-4 months for your eyebrows to return to normal but the positioning will improve as the some of the Botox wears off over the next 6 weeks. I would followup with your injector to discuss your concerns.

Nicholas Gentry, MD · Answer

it appears that your forehead was slightly over treated achieving relaxation of the muscles and reduction of wrinkles but causing a heavy brown appearance. At rest your eyebrows sit lower than before. Visit your injector again to see what they think but I would treat your glabellar region and try a lateral brow lift to help smooth things out. Next time I would reduce the number of units and consider adjusting sites of injection for the forehead to achieve a better balance.

Vicki J. Levine, MD · Answer

Other than just waiting it out for the botox to disappear  it is possible you might feel better if you go back to your doctor and get more Botox injected into the glabellar region. This will help raise your eyebrows to some degree .

Leonard Grossman, MD · Answer

After reviewing your photographs, I believe you had a little too much Botox injected into the forehead, especially if this was your first treatment. There's not much you can do at this point in time but wait it out and let botox wear off naturally. Next time you have your treatment, make sure you mention the the observed effect. Good luck for New York City

Anteneh Roba, MD · Answer

The heaviness you feel could be due too much Botox injection in the frontals muscle (the forehead muscle) . I would see your injector to discuss ways to correct your condition.

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