Does 20 units in frontalis have the same effect regardless of injection sites? (Photo)

Hello Modest.  We agree with some of the feedback that you have received that 20 units above the brows is a heavy dose and most patients do not need that much.  Unfortunately, you will probably have to wait for the situation to get better.  

Some before and after pictures would be helpful. Your injection sites don't really look too low, so my guess is that 20 units of Botox is just too much for your forehead. I see this happen routinely when nurses and injectors use a "one-size fits all" approach to Botox injections. We are all different, our forehead muscle anatomy is different and our muscle strength is different. I have rarely had to use more than 10-15 units for a woman's forehead when strategically placed. Weakening the depressors may provide some improvement, but it may be wisest to just let the Botox wear off and start over with a more experienced injector. Hope this helps answer your question.

Flattening of the brow can occur if the muscle is weakened too much. It is important to visit with an experienced injector. An evaluation should be done prior to injection to determine the best treatment pattern for you. Botox effects will fade gradually over three to four months. The Botox is in full effect after two weeks.

Thank you for your question Modest9950. I understand your concern. Botox is a purified protein used to address wrinkles associated with facial expression. When injected into the skin Botox will relax the muscles and smoothen out the overlying wrinkles. The most common areas of treatment are in the upper face. These include the horizontal lines seen on the upper forehead when one raises the brows, the vertical lines seen between the brows when one frowns (frown lines), and the crow's feet seen around the eyes when one smiles.
It is difficult to make an assessment in the absence of consistent photographs before and after in the same lighting and angles for comparison. However, I hope the information provided here is useful.The pivotal studies used 20 units of Botox in the forehead area above the brows to address the horizontal lines seen when one raises the brows. These studies demonstrated that the peak results are seen 14 days after the treatment and most people enjoy their results for 3-4 months. At that point, a maintenance treatment is recommended. While some people start to see results as early as the next day, it can take two weeks for full results so patience is important. We have our patients return two weeks after their treatment to assess their results via photographs. At that time additional units may be added if necessary. 
The pivotal studies for the horizontal lines on the upper forehead were published many years after doctors had been using Botox. In these studies, 20 units of Botox were used to treat this area. However, in my experience I find that anywhere from 10 to 20 units works well in this area. For patients with narrow foreheads a lower dose may be used and those with a broad forehead generally require higher doses. I have also found that the full results in this area are seen by two weeks. Therefore, we have our patients return two weeks after their treatment to assess the results via photographs. At that point additional units may be used if further enhancement is desired.
When patients present with concerns about specific wrinkles in the upper face such as the frown lines, I always assess and usually treat the other wrinkles in the upper face including the horizontal forehead wrinkles and crow’s feet. The reason is to maintain a harmonious and natural balance to the appearance of the upper face. The muscles in the glabella which are responsible for the formation of the frown lines serve to pull down on the inner brows when a person frowns. Similarly, the muscles around the eyes which are responsible for the formation of the crow’s feet seen when smiling (orbicularis oculi) are also responsible for pulling down on the brows, but in this case the outer brows. On the other hand, the muscle in the upper forehead which is responsible for the formation of the horizontal forehead wrinkles when a person raises the brows (frontalis) serves to pull the brows upward. If one of these muscles is relaxed with Botox and the others are not, the other muscles will still be active. This will lead to an unbalanced and unnatural appearance of the upper face where the brow can be elevated, depressed, or uneven in shape or position. Therefore, I recommend that my patients take a global approach to the upper face when receiving Botox treatments and treat all three of these areas. Sometimes bunny lines on the bridge of the nose are also treated.
When Botox is used in the upper forehead, if the dose is too high or the placement is too low it can result in the feeling of heaviness in the eyebrow or even lower the position of the brow. In order to reduce the risk of this possibility, I use a conservative dose in the area and place the product high on the forehead, sometimes near the hair line. Additionally, I recommend that my patients simultaneously receive a small amount Botox between the brows and at the corners of the brows. This will relax the muscles that pull down on the brows to counteract this effect and provide a harmonious balance to the position of the brow. The results are assessed two weeks after the treatment. If there is any asymmetry a small amount of Botox can be placed in the upper face for correction.
If I had a patient with the concern described here I would say treating the glabella area and crow's feet will help counterbalance the heavy feeling in the eyebrows. The reason is as follows. The muscle in the upper forehead is now relaxed after a Botox treatment. Therefore, the muscles in the glabella and crow's feet which pull the brows down are now acting unopposed. Relaxing these muscles will relieve the stress and possibly provide a natural appearance and feel. In terms of the dose and placement of the product, different patterns may be used depending on the individual and the locations of their muscles and wrinkles. The time it takes to wear off is more dependent on the dose than the pattern used for the injections.With any injection, there are risks such as pain, bleeding, bruising, redness, swelling, tenderness, and infection. We take special precautions to minimize these risks such as using a painless technique. We also treat bruises with a laser as early as the next day. Bruises usually resolve within two weeks if untreated. After a laser treatment bruises usually resolve in 1-3 days, but may still take two weeks for full resolution. In addition to these risks, with Botox there is also a risk that the product spreads or diffuses to nearby structures. Spread to nearby muscles can lead to side effects such as the temporary appearance of droopy eyelids or a temporary asymmetric smile.

After a Botox treatment, I recommend that my patients avoid heat exposure, alcohol consumption, and strenuous exercise for 24 hours and not lie down flat for four hours. This is because all of these activities may possibly lead to the movement of the product and consequent side effects such as droopy eyelids. Although there have been no definitive studies shown that these actually occur and some physicians do not provide such aftercare instructions, in the absence of data I err on the side of caution and recommend that my patients avoid such activities.

Please consult with a doctor for specific recommendations. Good luck!

injection into the frontalis is actually into only one large muscle and the toxin needs to be spread out over the muscle and it does not make any difference as to the number of sites as long as it is distributed throughout. your issue is that it was injected too low and this will cause the problem with the eyebrows

There are 2 ways of injecting Botox. One is to do a few sites and depend on diffusion to distribute it to the entire muscle that you are trying to paralyze. The other is to put small aloquats into the muscle in multiple areas, distributing it yourself to where you want it. I prefer the latter, similar to what you had. This method also lasts the longest since you are not waisting any of the injected Botox that does not get to where it is intended. The effect will probably, therefore, take 3-5 months to fade. Right now, removing any brow depressor is all you can do. The problem was that the original injector did not recognize what was holding your brow up. You should, therefore, never treat the forehead again.