I use Botox for migraine prevention but it distorts my eyebrows, is there a way around that? (Photos)

Question

I loved my eye brow shape before BOTOX. I am a chronic migraineur and BOTOX brings immense relief. But, it distorts the brow shape, even when the dr injects high in the forehead. Is there anything to be done? Besides being distorted, the brows are not symmetrical between L and R.

Orna Fisher, MD · Answer

When botox is done specifically for the prevention and treatment of migraine headaches the priority is different than when we do it for cosmetic purposes. If you are really bothered by how your eye brows look now, my suggestion is that once this round has almost worn off, you have it done for cosmetic reasons and see if it still works for your headaches. Of course insurance won't pay for that, but it's very possible that you will have both benefits, as a number of my patients do. If you try it and it doesn't work nearly as well for your migraines then you will know what you have to do.

Alexander Rivkin, MD · Answer

Hi and thank you for your question.  There are a few options that my help your situation: One would be to either lower the dosage used in your forehead (which may result in more frequent visits as the Botox may not last as long in lighter doses). Another option is to have your injector focus on the temporalis muscle, since most migraines tend to affect the side of the head rather than the forehead.  You may also try visiting an injector who specializes in aesthetics to treat the forehead for wrinkles so that  symmetry is achieved, and consequently, will get relief of your migraines!  Best of luck.

Michael A. Zadeh, MD, FACS · Answer

Hi Natasha. The doses of Botox that we give to the forehead for Migraine treatment and prevention is often much higher than what we give for cosmetic purposes. This can cause significant weakening of the forehead muscle and dropping of the brow with loss of shape. You have to consider what is more important to you, migraine prevention or nicer shaped brows. Options for this would include using less Botox and placing the Botox differently to maintain your brow shape. Discuss your concerns with your injector. Hope this helps answer your question.

Aldo Guerra, MD · Answer

I think you can have a conversion with your injector and discuss the issue with the eyebrows and show them the photos. It's possible with very careful technique some of the changes can be lessened and perhaps you will feel more satisfaction.Good luck, Dr. ALDO

Mark T. Boschert, MD · Answer

So I would suggest you see the board certified plastic surgeon who has experience treating migraines with Botox. There are other surgical techniques the plastic surgeons have which can permanently remove the nerves that trigger the migraines. This would allow you not to get the field effect of Botox across her forehead and would leave your eyebrow shape as is. I personally know that Botox works great for migraines but with long-term use it may be more cost-effective to consider a surgical procedure. Best of luck, Dr. Boschert

Aurora DeJuliis, MD · Answer

Botox injected by a neurologist for migraine headaches is not a cosmetic procedure and the Botox used is not cosmetic Botox.

Samir Shureih, MD · Answer

The position of the eye brow is determined by the action of several muscles. The main ones are the currogator muscles and the frontalis  and orbicularis muscles. any thing that affect ant of these muscles will affect the shape and position of the brow.The expert on Botox and migraine is Dr. Bahman Guyuron in Cleveland Ohio. I would surely consult him

Kurt Kuhlman, DO · Answer

Your insurance company is paying for your doctor to follow a protocol of 31 very specific injection sites approved by the FDA to treat your migraines. Unfortunately, this protocol is not perfect because everyone's anatomy is slightly different.  I suspect that you have a low-lying frontalis muscle and when your injector is injecting your "procerus" and "corrugator" sites, he\she is actually injecting your frontalis muscle, resulting in your left medial eyebrow to droop. If you research FDA approved injection sites for Botox migraine you will see 3 sites straight across above the brow, but Botox cosmetic for frown lines will show 5 sites in a triangle shape with the procerus muscle injected much lower than when injected for migraines. A simple technique to help you: Draw a line from each medial (inside) eyebrow to the opposite medial canthus (inside corner of the eye). Where these 2 lines intersect is where to inject your procerus muscle. This is about a centimeter lower than the FDA approved procerus migraine site. The corrugators muscles are easy to visualize when you frown. If your injector goes straight in at a 90 degree angle and not up he/she should avoid injecting the frontalis muscle. Allergan does a great job at helping their physicians with any "adverse events". I am sure that if your injector presented your case to Allergan, they would provide assistance to help with your distorted eyebrows.

Leonard Grossman, MD · Answer

You you can most definitely have the results that you wish for. All you have to do is see an inexperienced injector and show them the photographs of yourself with your preferred appearance for eyebrows. Good luck from New York City

I use Botox for migraine prevention but it distorts my eyebrows, is there a way around that? (Photos)

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