Is there a limit to how many times you can have Botox? Once your brows have dropped one time, is that it for you ?

Question

My last botox treatment was 17 months ago. My eyebrows fell. My surgeon said "If you cause atrophy of the muscle it does not regain its strength & so can't raise the brows. You can't do botox again." Another expert said "If you re-injected these specific muscles repeatedly over a short period of time to cause such a semi-permanent relaxation, then you can atrophy them, but you won't cause your eyebrows to droop more over time. It might actually delay further drooping." Whose right? Anya (70)

William Andrade, MD · Answer

Hello, if your brow dropped after Botox was injected, perhaps you simply needed a lower dose or different injection sites.  You could seek other opinion with an experienced injector to review your options.

Jason Emer, MD · Answer

you can use botox forever, it will not cause signficiant atrophy that will be noticeable.  if you have brow or eyebrow drooping i suggest waiting a little or having less dosage put in the next time.  This will resolve after the botox wears off.  Best, Dr. Emer.

Michael I. Echavez, MD · Answer

Botox treatments are individualized to each patient and the placement of the injections can affect the eyebrows.  I do not know the details of your particular treatment, but it is possible to treat the forehead and not cause any significant drooping of the brows.  The brows can lower if the Botox is placed too low on the forehead.  If you had drooping of the eyebrows after a treatment, you should be able to be treated again, but the location of the injections should be altered so as not to cause drooping again.

Nelson Castillo, MD · Answer

Thank you for your excellent question. Yes, repeated use of Botox may cause a mild muscle atrophy, but as Botox is a temporary medication, this atrophy is also temporary.  Once the Botox wears off, activation of your muscles will eventually cause hypertrophy back to its original size.  Depending on the location where you are receiving your Botox, i would not expect your eyebrows to droop any further over time. Hope this helps.

Benjamin Barankin, MD, FRCPC · Answer

There is no limit on the number of botox treatments that you can have. There are people that have received botox for more than 20 years and there have been no issues. I would try a different injection technique and/or different dosing with your dermatologist to prevent your eyebrows from falling; it should be preventable.

Ben Talei, MD · Answer

You can definitely have botox performed again, but just be more careful with the concentration used and where it is injected.  Less concentrated reconstitutions of botox need more fluid to achieve the desired result which theoretically increases the chance of drifting.  If both brows drop you can try and fix immediately by having a specialist inject directly under the brow.  To prevent the issue next time you would likely have to inject higher over the brow and use a more concentrated solution.This is the correct answer.  I would not worry about atrophy and brow drooping permanently after a single injection.  It's even difficult to do with multiple repeat injections.

Jeffrey M. Joseph, MD · Answer

Hi Anya, thank you so much for your question. In my experience a heavy or drooping eyebrow after Botox injection is almost never related to chronic changes or atrophy. This undesired effect is almost always related to the technique, placement, or amount of medication given to each muscle group. Injections that are too strong, too deep, or too far lateral on the forehead can all lead to drooping of the brow. My advice would be to consult with an experienced injector and plan a treatment with a new injection pattern being careful not to over treat the forehead area. Best of luck.

Robert S. Schmidt, MD · Answer

Thanks for your question. There are no hard rules on how many times a person can receive Botox. It all depends on how your body responds to it. Both doctors are correct in that Botox does cause muscles to atrophy over time. Eyebrow position depends on a balance between the muscles that pull the brows up and the muscles that pull them down. If your brows have drooped, it means either your depressors are too strong or your elevators (the forehead muscle) are too weak. It sounds as if you currently have very weak forehead muscle from the treatments you have received to date.If I was you, I'd hold off on more Botox until your forehead starts to move again. If you haven't had surgery on your forehead or temples, it should start to move again if given enough time. If the muscle moves a tiny bit, you can try to exercise the muscle to try to get it stronger, faster. If you're concerned about brow droopiness, you can also consider a surgical brow lift which would be a potentially permanent solution.

Is there a limit to how many times you can have Botox? Once your brows have dropped one time, is that it for you ?

Answers (8)

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