Why do my eyebrows drop with Botox? Can more Botox help with the drop? (photos)

Question

I have one eyebrow much higher than the other. it has become way more noticeable over the past year and a half. One eye is suddenly becoming more deep set. Eyebrows have really dropped so I thought Botox might have helped with some of it! Both times I've gotten Botox they have fallen, both of them.What should I do? I'm 35. Should I wait on getting a brow lift! Also, I've had a lot of hair loss in the front which makes my forehead look much bigger. What would be some good options for me?

Kyle Coleman, MD · Answer

In patients with pre-existing low brows, botox in the forehead can lead to a lowering in the brows.  This can exacerbate some pre-existing asymmetry.  In patients prone to this, it is often more advisable to use less botox in the forehead to counter the downward forces.  Additionally, in patients with asymmetry of the brows, the cause is usually bony asymmetry which can often be addressed with a small amount of filler.  Seek out another physician who is an expert in injectables.  Best of luck.

Yannis Alexandrides, MD, FACS · Answer

I would be curious to know whether this is happening with the same practitioner…   The establishment and price will also be an indicator of the quality and efficacy of the treatment. Try to avoid going to people's homes to have treatment, instead, visit a reputable clinic and have the Botox administered by an aesthetic nurse or plastic surgeon if you haven't already done so. Dropping can occur for a number of reasons: Sometimes Botox injections can be placed too low, or too much of the substance has been placed in your forehead (this can happen if you have a small forehead) or the product has migrated to the levator muscles - you should rest assured that the effects will subside within 3-6 months and won't be permanent. However, you mention that the asymmetry was there before you started having the Botox. Whilst Botox can be used to rectify asymettric brows, the best solution might be an endoscopic brow lift.

Jason Emer, MD · Answer

This may be due to Botox placement. If you're unhappy with your botox results, venus legacy and thermage treatments can soften results. Brows can be lifted with a combination of Botox with lasers, microneedling/prp, ultherapy and radiofrequency. See an expert. Best, Dr. Emer

Kenneth D. Steinsapir, MD · Answer

The basic botox treatments do not provide doctors with the tools needed to control the eyebrow.  There is a lot of talk about shaping the brow or forehead with botox but standard methods do not reliably accomplish this.  Treatment in the forehead freezes the frontalis muscle of the forehead and causes the brow to fall.  I have a patented cosmetic botulinum toxin method called the Microdroplet Lift® that leaves the forehead untreated.  Instead, it concentrates treatment along the eyebrow where the brow depressor muscles live.  Weakening these muscles allows the eyebrows to go up.

John Tang, MD · Answer

Thanks for sharing your concern.  It sounds like the Botox was not done correctly if the eyebrows have dropped.  This is because either there was too much botox injected, the placement of the botox was incorrect, or both.  I would recommend that you go to someone else - a cosmetic surgeon who has great experience and knowledge in doing botox in this particular area (this matters the most).  Another option is to consider doing Ulthera which can also lift the eyebrows.

Gordon Andan, MD · Answer

Hello, and sorry to hear about your bad experience with BOTOX®. Unfortunately, adding more BOTOX® to this same area would result in even more eyebrow drooping, so I wouldn’t advise tackling this problem with more injections just yet. You may need to wait until your current BOTOX® has dissolved before consulting an experienced cosmetic surgeon or skilled injector to carefully placed a second round of injections above your brows. If not placed properly, or if too much product is used, this can lead to the drooping effect you’re currently experiencing.
As for whether or not you should hold off on a brow lift, this is something that I would bring up with your cosmetic surgeon as well. At 35, you might benefit from waiting a little longer before getting a surgical procedure, but this can depend on a variety of factors. My best advice is to find a reputable cosmetic surgeon in your area and discuss both of these questions in more detail.

Kate Kleydman, DO · Answer

often times it is not the eye brow that is actually drooping. Rather it is the relaxation of the forehead muscle that leads to the eyebrow shifting downward. This small shift can be enough to crowd the upper eyelid skin and give the appearance of a lower seated eyebrow.  It's important for your doctor to make this distinction which is why a follow up visit may give you some assurance. everyone's face is asymmetric and successful Botox treatment requires an understanding of the facial anatomy, the subtle difference from one side to another and an adjustment of injections accordingly. Thank you for your question

Iacob Marcovici, MD · Answer

To give a pointed answer to your question I do believe it is important to have a careful evaluation when your forehead is free of Botox treatment

Shaun Patel, MD · Answer

Sorry to hear about your experience. Neuromodulators such as Botox and Dysport can be used to raise the eyebrows and to improve eyebrow symmetry. In your case, you are experiencing the opposite either because too much Botox is being used or the Botox is being misplaced. I recommend you consider another injector for your next treatment and have a conversation with him/her about your prior experience with Botox. Good luck.

Jo Herzog, MD · Answer

This is a case of less is better and too much of a good thing  destroys the results. With proper placement and quantity one can achieve a lovely lift and reshaping of the brow in a few different ways depending on desired result. I see a lot of people that come to me to fix what they got when they purchased some bargain Botox from an inexperienced injector. If you use someone experienced you are more likely to have less injected and actually spend less then if you ran for a $10/unit Botox special ad you should not get a heavy brow. However, sometimes you have to settle for some movement of the forehead to get the best brow lift.

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