How do I prevent this from happening again after a botox brow lift? (Photos)

Question

Hello not sure what happened I had a botox from an MD and it appeared they did it properly so I don't blame them. Had a brow botox lift and they look great with the exception of when I lift them. One shoots up high. What went wrong and am I a poor candidate? I had it corrected with more botox and now they are symetrical but I no longer have a brow lift.

Jason Emer, MD · Answer

For unique cases where a variety of modalities could be used to treat the condition, I would suggest an in-person or virtual consultation to develop a custom and effective treatment plan.  It is difficult to precisely define the best option without collecting the same information. I suggest reaching out to an expert for a consultation with surgical and non-surgical methods to get a comprehensive option. Best, Dr. Emer.

Jonathan Kulbersh, MD · Answer

Hello, thank you for your question. It seems you were able to reverse the higher brow with more Botox, and this is a common occurrence. It can be a matter of changing your dose for future treatments so you still have the lift without the higher brow. Dermal fillers can also help with brow atrophy and can be used in combination with Botox treatments for more noticeable results. Keep in mind that Botox injections require a great deal of precision, skill and artistry to produce an optimal outcome. Always work with injectors who have the experience and qualifications necessary to achieve the best results.

Nelson Lee Novick, MD · Answer

The simple answer to your question is that the Botox was not injected properly giving rise to what has been descrbed as the "Spock" (from Star Trek) or Mephistopholes arching to the lateral eyebrows. Properly injected, Botox is routinely used by experienced injectors for the a "chemical browlift" (i.e. to elevate and create the more desirable subtle, feminine upward and outward flare of the outer third of the eyebrows without created the Spock look. The use of too much Botox in the area can lead to, as in this case, loss of the desired effect. Make sure to consult with an experienced, board certified cosmetic dermatologist. Best of luck.

Dean P. Kane, MD, FACS · Answer

Dear goodgal46, 
Thanks for sharing your photos. You appear to have mild upper eyelid skin excess with residual upper forehead creases in repose and asymmetric brow lift with a bit of eyelid lift improvement when elevating the brows following botox. 
•	It is always easier to improve a under-treated brow-forehead with botox injection with a touch more botox 2 weeks later (even if the middle brow-peak (“Spock”) or later brow-peak (“Mephisto”) appearance occurs; rather than over treat across all forehead lines developing a untreatable brow ptosis. Following brow ptosis, the botox effect will require a 3 month time for reversal. 
•	The explanation of why this occurs is complicated. Yes, it is partially technique but it also is changing anatomy. The more one uses botox, the more muscle fibers are quieted and therefore the combinations of facial muscles of expression change; requiring re-evaluation of where and how much to inject. You may consider a hyaluronic acid filler to the transverse lines across the forehead rather than experience brow-ptosis and brow-peaking issues like the one you have experienced. 
•	You are not a poor candidate for continued “botox” brow lift.
•	Consider a bilateral upper eyelid lift
•	If and when, the skin slides over the forehead muscle and ‘botox’ appears ineffective, consider a brow lift: PDO thread, skin-lift, endoscopic.
I hope this helps. All the best!

Roberta Huang, MD · Answer

Did you have your forehead treated when you got the brow lift? The most likely reason the brow is spiking in the first picture is that the forehead was undertreated in the area above the peak of the brow. This is a common asymmetry resulting from forehead Botox, and is easily corrected, however the movement of the brow will be limited as you're now experiencing. It's hard to assess if you're a brow lift candidate without seeing you close your eyes tightly and smile big. With Botox treatment, you're always balancing the pull of the muscle - the forehead muscle pulling up on the brows and the crows feet muscle pulling down and in. Usually a balance can be achieved with proper placement and dosing.

Camille Cash, MD · Answer

I encourage you to return to your injector for a touch up.  The concern that you have when you raise your brows can be corrected with a small amount of product.  Your injector should take careful notes of where and how much was injected at each site to prevent this from reoccurring in future treatments.

Kurt Kuhlman, DO · Answer

You have a Spock brow. This is very easy to fix. Go back to your provider and have them inject 2 units of Botox in the frontalis muscle above your lateral right brow and this will resolve in a week.

Liliya Slutsker, MD · Answer

Brow lifting with Botox is misnomer. The Botox procedure cannot lift the brow. The brow lifting and brow position could be determined by two sets of muscles: Frontalis and orbicularis. Frontalis muscle lifts a brow as in surprised expression. By the same token it causes wrinkles.When Botox is placed it’s an estimation how much Frontalis muscle strength can be weakened by it. A little more and brow can’t be lifted, a little less and brow will be lifted and wrinkles will be still there, or more pronounced.First picture shows exaggerated brow lift with wrinkles: this part of muscle works even harder compensating the loss of muscle strength in nearby muscle fibers.The second picture Botox was added and as a result no wrinkles, no brow lifting.To optimize the wrinkle relaxing effect of Botox and the ideal position of the brow for the particular person, determining the muscle strength and strategically placed Botox( sometimes in very small increments) is a key or it called the art of beautification process.

Jo Herzog, MD · Answer

A brow lift with a neuromodulator is all about balance. When you treat the g;abellar area and the muscles around the brow you can lift the brow by stopping those muscles from pulling it down. If you treat your forehead  creases you are stopping those muscles from pulling your brow up.  The lower and deeper you inject the forehead the more you can drop your brow. Everyone is different so you need to work with your doctor to find the right balance. You can not always have it all. I tell my patients that they might have to accept some forehead wrinkles if they want maximum brow lift.

Rita Rakus, MBBS - Account Suspended · Answer

Hello and thank you for your question. It is always best to see you face to face for a consult and examination however in this case it looks as though you needed a little more in your upper right of the forehead on initial treatment. As we age it becomes increasingly hard to create a lift (by treating between the brow and round the eyes) and Geta. smooth forehead (by treating the forehead). The best way to get the most lift possible from botox is to leave the forehead/frontalis muscle alone without treatment.  I hope that helps answer your question. Always seek an experienced and qualified medical professional for these treatments. Very best wishes

How do I prevent this from happening again after a botox brow lift? (Photos)

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