Botox, is it supposed to look like this? (photo)

First time doing Botox. I asked for forehead only. She told me I should do gabella too but I didn't want everything done my first time and the forehead lines are the ones I feel more concious about. She said if you don't do the gabella, it will weird but ok. And now after 3 days and a half it looks like this.

Doctor Answers 26

More time for Botox to work

Hello rachelg234,

Thank you so much for your question and photo. We do not have a "before" photo to compare thus unable to see what progress has been made. Secondly 3 days is not sufficient to make any determination as to effectiveness, correct dosage and areas potentially in need of a touch up. Make plans to go back to the office where you had your Botox at the 2 week mark and any touch ups if needed or other concerns can be addressed. Being your first time many will treat very conservatively to assess your response and fine tune after that. I am of the camp that believes for best results overall counter balancing the forehead with the glabella region or vice versa is a good idea. Tincture of time is needed at this point. Be well.


Greenville Physician
5.0 out of 5 stars 3 reviews

Peak effects of Botox are at about 2 weeks after the injection session - you do need to balance glabella and forehead

Thank you for your question. You submitted one photo and describe you had Botox™ for the first time, and your physician recommended, in addition to doing the forehead which you want done  alone, you do the glabella as well. You decided to have just the forehead done, and submitted a photo three days after the procedure and ask if it looks normal.

I can give you some guidance on how to continue with Botox™, and understanding the process. It’s likely your doctor discussed this with you, but since this is new for you, it is important to understand some basic ideas.

A little background: I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial plastic and reconstructive surgeon. I’ve been in practice in Manhattan and Long Island for over 20 years. My specialty of oculofacial plastic surgery was among the first physicians using Botox™, so I’ve been using Botox™ for patients since 1993.

To begin, it’s very important to understand the concept of how Botox™ works. People often believe Botox™ is a filler, which it is not. What Botox™ basically does is improve the appearance of wrinkles. There are 2 types of wrinkles: dynamic wrinkles and static wrinkles. Dynamic wrinkles are wrinkles that occur when you activate muscles. Static wrinkles are wrinkles that occur regardless of muscle activity, so are present at rest.

Botox™ relaxes muscles. The forehead with the glabella are actually 2 different sets of muscles. The forehead muscles you want to smoothen is the muscle that lifts the eyebrows called the frontalis muscle. In the photo you submitted, it appears you have some movement of the frontalis muscle in the lower part, while the upper part looks relatively smooth. It is likely the area your doctor injected, and limited the area closer to the eyebrow, or the glabella. The glabella is the area where the frown lines are, and is often done in combination to help rejuvenate the forehead. As an aesthetic unit, you want to improve the horizontal lines in the frontalis muscle, and as the vertical lines AKA number 11 lines of the glabella.

Your doctor was likely concerned it may look unnatural or not in harmony. It is also important to understand the timeline for the effects of Botox™. You can start seeing changes as early as 24 to 48 hours, but in my practice I have people come back in 2 weeks. Clinical studies shown the peak of effect Botox™can be around 2 weeks, so that is when I determine the effectiveness, and whether enhancement is needed.

Another important element is what is causing the horizontal lines to form. People often raise their eyebrows very aggressively because they have drooping brows, or have extra skin over their eyes called dermatochalasis. Unconsciously, people will reflexively raise their eyebrows, which form horizontal lines, so it is a challenge for the practitioner. Since I don’t see the rest of your face, this is just some additional information.

You do not want to do Botox™ so aggressively that the forehead completely relaxes so the brows drop, or have a completely smooth forehead that won’t fit the rest of the face. Allow yourself some time to evaluate the result. Visit or contact your doctor in about 2 weeks from the time of your injection for reevaluation. Learn more about this, and I stress strongly to find a doctor you are comfortable with, and you feel can work with you as you continue your journey into doing this in a more consistent basis. I hope that was helpful, I wish you the best of luck and thank you for your question.

This personalized video answer to your question is posted on RealSelf and on YouTube. To provide you with a personal and expert response, we use the image(s) you submitted on RealSelf in the video, but with respect to your privacy, we only show the body feature in question so you are not personally identifiable. If you prefer not to have your video question visible on YouTube, please contact us.

Amiya Prasad, MD
New York Oculoplastic Surgeon
4.3 out of 5 stars 65 reviews

Botox

Thank you for your question and picture.  It is too soon at 3 days to know what the final results will be.  It usually at least 7 days for the full effect of Botox.  That said, and without seeing your pre-injection pictures, it may all correct itself or you may need more Botox in the glabella area.

Ramiro Morales, Jr., MD
Pembroke Pines Plastic Surgeon
4.5 out of 5 stars 25 reviews

Botox results

Thank you for your question rachelg234. I am sorry to hear about your situation. Botox is a purified protein used to address wrinkles associated with facial expressions such as the horizontal lines seen on the forehead when one raises the brows and the vertical lines between the brows seen when one frowns. In the face there are muscles that raise the brows and muscles that lower the brows. These muscles work in a delicate and harmonious balance so if one group is relaxed with Botox without relaxing the other group the appearance can look unnatural. For my patients I recommend treating both areas in order to avoid this possibility. Also it can take up to 2 weeks for full results of a Botox treatment. In our office we have patients return at that time to take after photographs  in order to assess the results. More Botox can be added at that time. Please consult with a doctor for specific recommendations.  Good luck!

Alex Eshaghian, MD, PhD
Encino Physician
5.0 out of 5 stars 1 review

Botox to upper forehead only

Hello rachelg234,I think that your injector was trying to steer you in the right direction. It appears that the product is working where it was injected. The lower portion of your forehead, including the glabella, is still very active and the disparity between the two areas shows a lot of contrast. Not all is lost though. You can return to your injector and have them give you a conservative treatment of the lower areas as well.Good luck!Michael M. Kim, MD

Michael M. Kim, MD
Portland Facial Plastic Surgeon
4.9 out of 5 stars 38 reviews

Botox for Forehead & Glabella

The Botox usually takes 5 to 7 days to see the full effect. It would have been a good idea to get it all at once as suggested by the injector, that being said nothing wrong with calling and getting another appointment for the Glabella and it will also soften the lines on the side.

Botox

It looks like you have strong forehead and glabella muscles.  It is difficult to treat those lower brow lines without causing the brow to drop especially when not balancing the treatment with botox in the glabella ( the muscles responsible for the vertical lines when you furrow your brow). It is not uncommon to start with a lighter treatment for a first time treatment and add additional botox if needed, so don't be discouraged  My personal preference is to treat these areas together and rarely treat the forehead in isolation.  However at  3 days post injection, botox has not reached its maximal effect so you may want to wait  a week, but there is a good chance you will need to return to your injector to discuss additional treatment.

Amy Kulak, MD
Jacksonville Ophthalmologist
5.0 out of 5 stars 3 reviews

Botox

It would have been a good idea to listen to your injector as they have the most experience.  Muscles need to be balanced and if they aren't this is what happens.  I'm sure if you return to your injector she can inject your glabella and you will have a more desirable outcome.

Martin Jugenburg, MD
Toronto Plastic Surgeon
4.9 out of 5 stars 437 reviews

Botox to forehead

First, botox takes about 5-7 days to get to full effect. Second, one can not knock out the lower wrinkles/muscle action or you  might get brow ptosis. Treating the glabella can soften the lower central lines.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 24 reviews

Botox - is it supposed to look like this?

Thank you for your photograph and question.  My advice is that you wait a full week before considering a full result from a Botox treatment.  My personal preference that Botox should be balanced, creating an overall smooth and natural appearance.  I wish you good luck.

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.