Will my Natural Eyebrow Arch Return Once the Botox Droop Wears Off?

Question

I have, or had, beautiful naturally-arching eyebrows. I had Botox injected for the first time last week by a board-certified dermatologist for my frown lines, though she also injected it right above my eyebrows above my pupils apparently into my frontalis muscle. Now my eyebrow arch is mostly gone and my brow is flatter across, and my eyelids have dropped a few centimeters--I HATE this sleepy look! Will my brow regain it's natural arch once the Botox wears off? I'm terrified I'm stuck with this.

Jerome Edelstein, MD · Answer

This may be caused by Botox and it will go away as the effects wear off. I suggest you wait for two weeks before assessing your results. If the arch doesn't come back at that time, then your injector can recommend something.

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

Sorry to hear about your situation -- the good news is that this is temporary and WILL improve once the Botox wears off...Lets discuss both of your issues -- the droopy eye-BROW (with loss of the arch) and the droopy eye-LID -- and some possible remedies...A Droopy Eye-LIDA droopy upper eye-LID may occur if the Botox is injected too close to your eyelid-elevating muscle, the Levator Palpebra Superioris. In such a scenario, the Botox will diffuse inadvertently onto the Levator muscle and cause an eyelid droop. A lower dose typically diffuses onto the levator muscle and so the other good news is that the eyelid droop will typically NOT last as long as the full Botox duration of 3-4 months, and may in fact resolve in less than a month. Note, however, that if the eyelid droop occurred shortly after injection (i.e. within 3-4 days), then your eyelid levator muscle likely received a significant dose of Botox and your eyelid droop may not resolve for 1-2 months or more...On a side note, you may have an increased risk of eye-LID drooping if you have a weakened upper eyelid muscle for neurological reasons, or a deeply set eye-BROW that would be more prone to drooping and result in skin gathering over the eyelid making the eyelid appear like it was drooping. During your consultation, your injecting physician should rule out both of these scenarios to ensure you are an appropriate candidate for Botox... Your thyroid disease is not a contraindication to Botox or to the treatment of your eyelid droop, which brings me to my next point...A droopy upper eye-LID due to Botox can be treated with Apraclonidine (aka Iopidine) eye-drops.  These eye-drops are commonly used to improve Gluacoma – a condition of high “eye ball pressure”.  However, besides lowering the pressure in the eye, Apraclonidine causes the Muller muscle in the upper eyelid to contract and lift the upper eyelid about 2mm.The usual dose of Apraclonidine 0.5% is 1-2 drops, 3 times per day until the Botox wears off.  (Note, make sure you put in one drop at a time, tilt your head back, and close your eyes to make sure none of the eye-drop leaks out.)   Apraclonidine should be used with caution in patients taking Beta-blocker eye drops (ex – Timolol), or certain pills for high blood pressure (such as Beta-blockers), Digoxin, and those taking MAO inhibitors (ex – Phenelzine) for Depression. Be sure your prescribing physician also discusses the potential side-effects of the drops, such as "adrenaline-like" symptoms like anxiety or heart pounding; you may also experience eye irritation, eye dryness, and eye pain, amongst other symptoms. If these symptoms occur, you will likely need to take some lubricating eye drops, lower the dose, switch the eye-drops, or stop the drops altogether...A Droopy Eye-BROWA drooping eye-BROW with a loss of your natural arch may happen in the following scenarios:(1) When the brow-elevating muscle in the forehead, the Frontalis, receives too high a dose of Botox.(2) The Botox is sub-optimally placed too low in the forehead; it should typically be placed at least 1 cm above the Brow. (3) It may also happen if you have a low set eyebrow to begin with, in which case any Botox to the Frontalis increases the likelihood of a brow droop. Ironically, as mentioned above, a droopy eye-BROW from Botox can sometimes be improved with MORE Botox -- this time, the Botox is typically injected into the outside (top of the crow's feet) part of the eye (aka the lateral aspect of the Orbicularis Oculi muscle) to generate a bit of a brow lift in that area -- by injecting more Botox and paralyzing the orbicularis muscle that normally acts to depress the brow in that area, you may get a slight compensatory brow lift (and even possibly restore some of your natural eyebrow arch)...If the extra Botox does not improve the brow droop, it will likely last as long as the full duration of the Botox -- 3-4 months.When it comes to Botox, I would recommend seeking, at the very least, 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. So, what kind of physician should be injecting your Botox? 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 as 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

Ron Shelton, MD · Answer

yes, your normal anatomic structures have not been affected permanently by Botox. Once the effect wears off, the frontalis muscle will elevate again, and with them the arch of the eyebrow will reappear. We can't afford to try to reduce all the horizontal forehead lines without creating some sagging of the forehead and so, there needs to be an understanding as to what can be accomplished by Botox and what can be affected in the neighboring regions.

Martie Gidon, MD, FRCPC, FAAD · Answer

Your brow droop may only last a few weeks or up to 2 months.  Next time, less Botox will probably be injected high on your forehead.  You may also benefit from a Botox brow lift to raise the outer part of your eyebrows.  When your Botox effect wears off, your eyebrow arches will return to normal.

Jonathan Weiler, MD · Answer

Yes, typically it will take between 2-3 months to see the return of these muscles with full return at 6 months. Botox is a wonderful tool to relax wrinkles and take years off your appearance, I would tell you to communicate with your next injector the displeasure you had with your last treatment and address the eyebrow arch you like. Good luck!

Will my Natural Eyebrow Arch Return Once the Botox Droop Wears Off?

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Will my Natural Eyebrow Arch Return Once the Botox Droop Wears Off?

Answers (9)

Answer: Botox and brow droop

Answer: Botox and brow droop

Answer: Will my Botox wear off?

Answer: Will my Botox wear off?

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Our mission is to create a world where every investment in modern beauty is Worth It.