Botox causing inner brows to droop. Any suggestions?

Question

Hello doctors, I had Botox injections for the 11 lines between the brows. After 10 days I am noticing that the glabella area skin looks looks thick and the inner brow lowered. I am wondering if additional Botox in an area would counter this undesirable effect? No Botox was injected in the central forehead other than a small amount very high on the outside of the forehead. Thanks.

Anil R. Shah, MD · Answer

Unfortunately, medial brow ptosis is a common occurrence with inexperienced botox injector. Medial brow ptosis or descent of the central brow can occur for several reasons:
-Botox placed too low within the frontalis muscle along the forehead including central forehead.  The frontalis muscle elevates the forehead and by decreasing activity here the central brow can drop
-Botox placed too superficially along the corrugator.  The botox will again impact the frontalis muscle and paradoxically lower the central brow.
Botox is best injected by an experienced injector to lessen wrinkles while improving facial appearance.

Jerome Edelstein, MD · Answer

There are options to fix the issue you're experiencing and you should see your injector immediately to work out an action plan for this. Either way, the situation will begin to resolve itself as the Botox wears off.

Lorrie Klein, MD · Answer

I agree with most of the other doctors.  Go back to your doctor or if he/she is not an expert injector who does this all the time, then visit someone who is to fix it.

Jennifer Reichel, MD · Answer

Botox injections to the forehead (11 lines, or the horizontal forehead lines) can cause the brows to either droop, or become over elevated. It is the interaction with the frontalis muscle (elevator) and the procerus/corrugators (depressors) muscles. The ideal result may be different for different patients. Most want to elevate the outer part of the brow. If you have brow droop (ptosis), then the injections may have been done too close to the brow, or have diffused to affect the brow level. If you have "Spock Brow" then 1-2 units placed above the upper area of the brow can fix this. If you have too much droop in general, there isn't much that can be done to fix it other than wait it out. The effects of the botox will decrease over time. Since it is not permanent, drooping will always get better. I do recommend that you call or see your doctor to discuss options and outcomes. That way they can adjust the injections for you in the future.

Michael H. Gold, MD · Answer

Thanks for your question and I would suggest that you return to your provider now to see what exactly has gone wrong and how the best way to reverse this or fix this. A board-certified dermatologist or plastic surgeon can help you the best – we understand these toxins the best and the anatomy of the areas we are treating here.

Deborah Kessler Hudak, MD, MHA · Answer

Done properly, there should be elevation of brows from Botox injections.  By "properly," I mean that the proper amount of botulinum toxin units and proper place of injection was done.  If either of those was done incorrectly, you can experience a brow droop.Too many injectors use a "cookie cutter" approach to Botox injections, and get untoward side effects in some of their patients.  Experienced hands make all the difference.  I can say those things because, as an Oculoplastics specialist, I have been injecting patients with Botox since 1992.  Also note that many of the Botox injectors, if not most, today are NON-physicians.  They learn a "cookie-cutter" technique for injecting Botox in a quick course, and do not customize the injection amounts and placements to the muscles in your face. It is sad, but true. Debbie Kessler Hudak, MD

Darryl J. Blinski, MD · Answer

We can not recommend more injections until in person examination is done. Or return to your injecting doc to discuss...

Steven F. Weiner, MD · Answer

What has happened is the frontalis in the central area of your forehead has been affected by the Botox through diffusion.  There is a depressor of the inner eyebrow called the depressor supercilii that can be relaxed and raise the medial brow.  A couple units at most for each side will help improve your problem.

Randolph Capone, MD, FACS (in memoriam) · Answer

Although annoying, it will improve and get less bothersome in the next 2-3 weeks.  My advice is to wait 4-5 months for the muscles of the central brow to awaken, and then when you get treated again, simply ask your doctor to use half the dose in the glabella that you just had. This should take care of it. And always see a Board Certified "core" cosmetic provider- dermatologist, plastic surgeon, or facial plastic surgeon- instead of someone who's practicing outside their specialty, regardless of their touted experience. You definitely run the risk of having these sorts of things happen with greater frequency & severity if you don't. Good luck!  -Randolph Capone, MD, FACS

F. Victor Rueckl, MD (in memoriam) · Answer

This is often referred to as a "Spock brow". It can happen, but it can be fixed pretty easily by an expert injector. A tiny amount of Botox near the upper outer edges of the brows will help counter what's happening. Either revisit your injector for an exam or make an appointment with another expert injector. "This answer has been solicited without seeing this patient and
cannot be held as true medical advice, but only opinion. Seek in-person
treatment with a trained medical professional for appropriate care."

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Botox causing inner brows to droop. Any suggestions?

Answers (10)

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