Dysport - Is this Spock Brow? (photo)

Question

I have gotten Dysport 4 times at the same establishment with one RN the first time and the last three with another RN, but every time the result is this (picture). Only my right eyebrow raises when i try to raise my brows. That side is also the most active and where movement and dynamic wrinkles come back once dysport starts to wear off. I went back the last two times to fix it but i wonder if my anatomy is to blame or should I look for a different injector since it always happens.

Ran Y. Rubinstein, MD · Answer

Hello and thank you for your question. It is not uncommon to naturally have one brow that is more dynamic or expressive than the other. To balance this, the forehead can be treated asymmetrically where the injection point/s above the hyperdynamic brow is slightly lower on the forehead than the other/less expressive brow to account for the increased motion. Hope this helps! Esther Litenatsky AGACNP-BC on behalf of Dr. Ran Y. Rubinstein, facial plastic surgeon in Newburgh, NY and Montvale, NJ.

Danielle Shanley, MD · Answer

It’s possible that your right eyebrow raises more due to muscle activity or product placement. If one side is more active, it might need slightly more Dysport to ensure both sides are balanced. Additionally, sometimes the product may wear off more quickly on one side if that area is more mobile or if the dose was lighter there.

It might be helpful to discuss this with your injector to see if a slight adjustment is needed for the right side. If the issue persists and your injector isn’t able to make the necessary changes, it could be worth considering a consultation with another injector to ensure they fully understand your anatomy and desired results.

Lexie Wang, MD · Answer

It depends on where they're injecting on your face as well as what the goal was. if your right eyebrow is raising still while the other isn't and they were injecting your forehead, then what that means is you just need more on the right forehead to balance out the left. if they were injecting your brow depressor muscles, then it means that they probably overdid it on your right side. what you can do is either go back to your injector and have them explain/troubleshoot what they've been doing but if they seem to not understand/be able to distinguish all the eyebrow muscles, then I would try going elsewhere.

another thing to know is that what an injector puts in you initially is always a "guess" - we need feedback to see if we hit what we were trying to target. This is why usually injectors will have new patients return in a couple of weeks so we can see if we got our desired goal or not. I'm not sure if you've specifically told your injector that this is your outcome and that you DON'T want that, but that might be helpful too because it's possible that your injector only ever sees you when you are "au naturale" , in which case they wouldn't know that you weren't getting your desired treatment goal.

Anna Chacon, MD, FAAD · Answer

It sounds like you're describing an asymmetric eyebrow lift, commonly known as "Spock brow," which can occur when Botox or Dysport is injected in a way that leaves some muscles more active than others. This can happen due to individual anatomy, uneven muscle strength, or an imbalance in how the product was placed.

In your case, since it's consistently happening with Dysport and primarily affecting the right side, it may be due to:

Anatomical asymmetry: If your right frontalis (forehead muscle) is naturally stronger or more dominant, it may resist the Dysport more, leading to uneven movement.
Injection technique: The placement and dosage may not be fully addressing your muscle activity on that side.
Metabolism differences: If that side moves more as the Dysport starts wearing off, it could be metabolizing faster there.
A small touch-up with additional Dysport in the overactive areas may help balance things out. You could also discuss alternative placement strategies with your injector to achieve a more symmetrical look.

Jeffrey H. Spiegel, MD · Answer

Some people are prone to a spock eye with Botox injections.  It means that one of the frontalis or lateral orbicularis muscle on one side is stronger than the other. In both situation the solution is easy and it may mean that you may need between 1-2 units of additional product injected to either muscle. As a seasoned injector, I can attest that this can and does happen even to patients injected for years. If an injector tells you this never happens, it means they haven't inject enough.

Camille Cash, MD · Answer

Spock brow typically refers to when the inner portion of the brow is down and the tail of the brow goes up.  You have asymmetry of the brows as they raise.  This can be addressed with a touch up of Dysport or Botox.  Visit an experienced injector for treatment.

DoctoraVital Med Spa - Cooper City · Answer

I understand your concern&mdash;you expect balanced and natural-looking results from your Dysport treatment, but you've noticed persistent asymmetry in your eyebrow movement. 
Without a before picture, it’s difficult to assess your natural muscle activity, but based on your description, it sounds like you may have an inherent asymmetry in your frontalis muscle contraction. This is quite common and can influence how neuromodulators take effect. 
Proper dosing and injection points should always be customized. In my practice, we create a detailed muscle map for each patient, tracking their unique movement patterns and adjustments over time. A follow-up at 14 days is crucial to fine-tune any asymmetries. If this has been a recurring issue, ensuring that your injector documents these adjustments&mdash;such as placing slightly more units in the right forehead&mdash;can help prevent it in future treatments. 
I hope you find the right approach that leaves you fully satisfied!

Dysport - Is this Spock Brow? (photo)

Answers (7)