I have extremely uneven eyebrows. I tried getting them reshaped, but nothing has helped. Is Botox something to consider? (Photo)

Question

I don't want to have to get surgery, but I am extremely insecure and want them to be more even. When I smile the extremely arched left brow sits extremely higher on my face than the right.

Anh-Tuan Truong, MD, FACS · Answer

Dr. Taban is correct.  You have left upper eyelid ptosis and your elevated left eyebrow is trying to compensate for the droopy eyelid.  Notice how your upper eyelid crease is larger on the left and your lid covers more of your pupil on that side.  Botox may lower your left eyebrow, but then the compensation is removed and your left eyelid will droop more over your pupil.  You should consult with an oculoplastic surgeon to correct your eyelid ptosis.

James M. Ridgway, MD, FACS · Answer

Dear Taylor,Thank you for submitting your question and her photographs.  As I am certain that you noted there are number of varying opinions regarding the treatment of your eyebrows.  However, not every solution needs to be a surgical in nature.  There are number of factors that account for brow asymmetry including, but not limited to, muscle tone, skeletal structure, facial expressiveness, muscle hyperactivity, muscular compensation, eyelid ptosis, and even nerve or muscle weakness.  In your particular circumstance a minimally invasive treatment with Botox can give exceptional results.  I hope this is helpful to you.Be healthy and the well, James Ridgway, MD, FACS

John Mesa, MD · Answer

Eyebrow asymmetries could be corrected with Botox in certain patient candidates. The paired forehead muscle ( frontalis) function is to raise the eyebrows. Sometimes eyebrow asymmetry is secondary to forehead muscle contraction inbalance.Botox, by weakening the muscles where injected, could balance the effect of the forehead muscles that control the eyebrow position, thus improving/coorrecting eyebrow asymmetries (see an example  of a male patient with eyebrow asymmetry treated with Botox in the link bellow).Correcting eyebrow asymmetries with Botox may require multiple treatments to tune the Botox dose that more precisely gives patient symmetry. Patients with eyebrow asymmetries that would like to consider Botox to correct eyebrow asymmetries should make a consolation with a Board Certified Plastic Surgeon specialized in Botox injections.John Mesa MD
Board Certified Plastic Surgeon
New York City (#NYC) & New Jersey (#NJ)

Jerome Edelstein, MD · Answer

Hello,

Thank you for your question.

It is very common to have facial asymmetry and
a difference in muscle movement on each side of the face. If this is something
that bothers you, it may be helpful to discuss subtle options for injectable
treatment, (Botox or Dysport for example.) with a skilled injector, and then
decide if that's the right option for you.

All the best.

Jason Emer, MD · Answer

I find that botox and fillers help when used properly. Thermage can help tighten and lift.  I suggest seeing a cosmetic dermatologist with experience.  Dr. Emer.

Mehryar (Ray) Taban, MD, FACS · Answer

Stop with eyebrow manipulation!  The problem is likely your left upper eyelid being more droopy (eyelid ptosis) which causes the eyebrow to raise in order to lift the droopy eyelid, so the solution is actually left upper eyelid ptosis surgery. See an oculoplastic surgeon for evaluation.  (Do NOT do Botox. It will make your left upper eyelid much more droopy.)

Brent Moelleken, MD · Answer

Botox, cleverly applied, would greatly increase the symmetry of your face.Uneven brows are actually much more complex than you might assume:  eye position within the bony rim, position on the horizon, upper eyelid shape and position, and set of the we within the bone all have to be factored in.An observant surgeon will steer you in the right direction!

Jason D. Bloom, MD, FACS · Answer

Botox can often be used to shape the brows with accurate placement.  You can raise certain parts of the brow by injecting into the brow depressor muscles and drop different areas by injecting the frontally or forehead muscle.  In your case, I would try to lift the tail of the right brow with some Botox under the brow peak on that side and laterally in the crows feet.  I suggest that you seek out a consultation from a trained and board certified injector.

Donn R. Chatham, MD · Answer

Most faces and eyebrows are asymmetrical and uneven. But when it becomes bothersome, this can often be improved using Botox. When we weaken the muscles that 'depress' the brows, then the muscles that 'elevate' the brows have an advantage and brows  rise  2 or 3 mm.    Also when we have a high or arched brow that we want to lower, we can place a few drops of Botox above this brow and the brow will lower by 2 or 3 mm. Effects last about 3 or 4 months.

Myriam Loyo, MD · Answer

Hi there,Thank you for sharing your photos. Botox can help raise the right eyebrow and drop the left eyebrow slightly. It is a temporary and definitely worth a try. An experienced injector should be able to help. When you get the injection, your injector will want to make sure you don't have any eyelid abnormality (like a droopy eyelid or ptosis) which would require a different treatment.Consider seeing a surgeon for your first injection as they will be more familiar with these eyelid conditions.   Good luck!

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