Why Do I have Puffy and Vertical Lines when Trying to Raise My Eyebrows After Botox?

Question

Hi, I just got my first botox done 5 days ago. She gave me 26 units on my forehead, on the side and underneath of both my teyes. She also injected 22 units between my brows. After 5 days, the skin below my eye brows seems folded and cover my upper eye lids. When I try to raise my eyebrows or open my eyes widely (which I am unable to do it yet). There are maybe about 5 or 6 vertical lines of wrinkles appeared the space between eyebrow and my upper eyelids. I look like a joker if eyebrow raise

Ron Shelton, MD · Answer

Fortunately you had glabellar botox to help eliminate the "11" but it also helps elevate the forehead. Without that, the forehead treatment, more than 20 units, can prevent the normal forehead function in elevating the forehead and eyebrows, so the eyebrows fall and bring with them the upper eyelids. The upper eyelids fold on themselves and when you try to lift them, the forehead isn't working well, and you may only be using the outer part of the forehead that wasn't injected by botox so there is an unusual direction of pull on the eyebrow.  This can create some vertical lines on the preseptal upper eyelid skin (between the eyebrows and upper eyelid crease). Fortunately this will all reverse itself and not be permanent. Next treatment you should probably have fewer units of  Botox  injected in the forehead. Don't try to eliminate all horizontal lines of the forehead as you need to have some muscle function to lift your forehead.

Ava T. Shamban, MD · Answer

The position of the brow is controlled by muscles that pull the brow up and those that pull it down.  The frontalis muscle (in the forehead) helps to pull the brow up and also creates dynamic lines on the forehead.  So when we treat the frontalis muscle in the forhead then we're also knocking out some of the muscle that pulls the brow up.  Treating the glabella (the area between the brows) and the tail of the brow relaxes muscles that pull the brow down.  In general, it's best to treat the brow elevators lightly relative to the brow depressors to avoid getting a "heavy brow."  In response to your question, the brow elevators may have been overtreated.  This condition will resolve itself over time.

Harold J. Kaplan, MD · Answer

I must first encourage you that if you are displeased with your outcome, speak to your injector. No two patients are alike, and it is so important to tailor a treatment plan to your specific anatomy.   A good injector knows this and open communication is important.  It typically take two full weeks for the final results of your botox injections to "set in." In our practice, patients are seen at the two week mark to evaluate outcomes. Without seeing photographs, I agree with the above panel members that it sounds as if your lateral frontalis is still active.  This is a correctable situation and easy to avoid next time.

Kenneth D. Steinsapir, MD · Answer

Freezing the forehead is a bad thing.  Freezing the central forehead is an even worse thing.  The central V for the 11 lines is generally a very appropriate treatment for most everyone.  However the muscle under the forehead, the frontalis muscle in the main elevator of the eyebrows.  Paralyzing this muscle does smooth the forehead lines but at the price of dropping the eyebrows.  If you are Marcia Cross (actress in Desperate House Wives) everything is frozen.  You get a very heavy eyebrow but no Joker.  When only the central forehead is treated, the frontalis muscle on the untreated edge of the forehead are still able to activate and this causes compensatory muscle activity in an effort to lift the eyebrows out of the eyes.  This produces the Joker look, the Vulcan forehead, call it what you want, it is not a desirable look.  To solve this problem, I developed a patented method called microdroplet botulinum toxin that actually leaves the frontalis muscle alone and treats directly the orbicularis oculi under the eyebrow.  It creates lift by weakening the eyebrow depressor muscles.  My website has much more information about this method.  I am in the process of teaching other physicians how to perform this technique.

	Your treatment will wear off.  Don't let you injector do this type of service again.  You encourage them to study my website or find yourself a different injector.

Carolyn Jacob, MD · Answer

however the final results for botox may take 14 days total.  If you feel like you have "hooding" of the upper eyelids, it is usually due to the fact that you may have low set eyebrows, and actually NEED to move your brows upward to prevent that hooding.  By relaxing the forehead muscles, you can not do that currently.  If you still see lines on the forehead, it's likely due to the fact that the Botox hasnt taken its full effect (but remember, that might make your upper lids feel heavier when it does).  If one part of the brow is too raised after 14 days, your doctor can add a small amount of botox to reduce that raise, but remember, it may affect the hooding of the upper eyelids if indeed your brows are too low set.  Best to you

Why Do I have Puffy and Vertical Lines when Trying to Raise My Eyebrows After Botox?

Answers (8)

Answer: You have correctly diagnosed the situation.

Answer: You have correctly diagnosed the situation.

Answer: Botox and Dysport can be used to treat the forehead

Answer: Botox and Dysport can be used to treat the forehead

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Everything you need to know about Botox

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Why Do I have Puffy and Vertical Lines when Trying to Raise My Eyebrows After Botox?

Answers (8)

Answer: You have correctly diagnosed the situation.

Answer: You have correctly diagnosed the situation.

Answer: Botox and Dysport can be used to treat the forehead

Answer: Botox and Dysport can be used to treat the forehead

Browse related questions

Recommended reading

Everything you need to know about Botox

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