Fixing Scary Eyebrows After Botox?

Question

I had Botox in my 11's (glabella?). It all looks fine but when I raise my eyebrows they stay down near my nose and raise up high with a real arch at the sides which makes me look kinda scary. My Dr said this was not a problem and easily corrected. What should I expect, where will he inject and how much Botox? Also what caused this? Did he do it wrong or does this happen sometimes?

Steven E. Rasmussen, MD, FAAD · Answer

As my colleagues have already answered, this is an easy fix with just a few units placed in the the frontalis muscle (forehead muscle) over the lateral eyebrow areas. 
In female patients who want a little lateral eyebrow raise, a few units can be placed within the lateral eyebrows which will weaken the muscle that is pulling down the eyebrows which will give them a natural raise in the eyebrow arch.
I hope that helped.

Jeffrey Zwiren, MD · Answer

There are muscles that function to elevate and depress the eyebrows. In the glabellar area, between the eyebrows, the corragator muscle functions to create the vertical 11 creases. This muscle is a depressor of the inner aspect of the eyebrows. When you physician injected the corragator muscle there was also some deactivation of the forehead frontalis muscle. This has resulted in an unbalancing of your eyebrows. To correct this problem it is necessary to weaken the lateral frontalis muscle with an additional injection of Botox. This result, especially if it was your first time being injected is not unusual. To avoid a plastic appearance it is best to inject the least amount of botox that will deliver the best result. On subsequent injections you should not have the same problem.

Nissan Pilest, MD · Answer

Your physician did not do anything wrong.
The lateral portion of your forehead muscle is compensating for the middle part that was relaxed by injection of Botox.
Injecting a minute amount of Botox above the lateral brow will correct this problem in no time.

Mary P. Lupo, MD · Answer

The reason this happened is that the medial frontalis got some Botox injected into it when the frown complex was injected (that lowered the medial brow) and no Botox was injected into the lateral frontalis (that caused a compensatory strengthening of the lateral brow and raised them too high). It is a simple correction requiring very little Botox to fix. The doctor will inject 2 spots above the lateral brows and in 3 days you will not look scary. Next time your dermatologist or plastic surgeon will make the adjustment so you will not need the touch up.

Edgar Franklin Fincher, MD, PhD · Answer

Don't worry, this can usually be fixed easily by adding small amounts of Botox to the outer parts of the forehead muscles.  This usually happens when the botox spreads and weakens too much of the middle forehead muscles.  
 
See your doctor and plan for a few small injections to balance things out again.
 
Good Luck

Arnold R. Oppenheim, MD (retired) · Answer

This is often called a Spock or a Jack Nicholson and happens with some frequency. 
    It occurs because the medial portion of the frontalis has been knocked out but the lateral portion is intact. When you lift your brow, the lateral portion lifts and the medial does not, creating the scary "Shining" Jack Nicholson look.
    Fortunately, this is the easiest BOTOX tweak. One to Two units are placed above the highest point in the brow. 
    Be sure to remind your physician what happened the last time so they can plan accordingly and place the BOTOX into the lateral brow area the first time.

Fixing Scary Eyebrows After Botox?

Answers (6)