Can the inner brow that is drooping more than before be corrected? (Photos)

Question

I had Botox injections and now feel like the inner brow is drooping more than before. Can this be corrected? I had injections almost two weeks ago and said that I wanted to lift my eyebrows. The situation now is that I feel like the inner part (the part I probably most wanted lifted) seems to be drooping more. I think I even have a bit of spocking. Can this be corrected and how? I am going back for my revision and would appreciate having a better understanding to avoid further issues.

Brock Ridenour, MD · Answer

Drooping of the inner brow after Botox has two possible explanations. Drooping of the brow can occur if the forehead is treated in conjunction with the frown lines.  Treatment of the forehead to reduce horizontal forehead lines will diminish the action of the frontalis muscle, which is the only "lifting" muscle of the brow.  If your forehead was treated in addition to your frown lines  then you may want to avoid future treatment of the forehead, especially if the goal is brow elevation. You could also consider a reduction in the amount of Botox used. A second explanation and a common cause of medial brow droop is that some of the Botox used to treat the frown lines "spread" upward into the frontalis muscle. This can occur if the injection is too high, or the injection was forceful, or the Botox solution used  was too dilute.  Either way, it will take a few weeks to correct. Rarely does the problem last the full duration of the Botox treatment. There is usually some compensation after a shorter period of time. I hope this helps. My very best.

Jason Emer, MD · Answer

Botox results last up to 3 to 4 months and can be softened with Venus Legacy and Thermage treatments. I recommend getting a formal evaluation with a cosmetic dermatologist. Best, Dr. Emer

Nirmal Nathan, MD · Answer

Dear bcn86,Thank you for your question. It is hard to evaluate your eyebrow position without the before photos. Botox should not cause your eyebrows to droop unless it was injected into your forehead. If you came in requesting a browlift, this would not be the correct way to do it. If the Botox is the cause of the drooping, you would have to wait for the Botox to wear off (3-4 mo) and then re-inject in a new pattern. Always make your your injector is reputable and has in-depth knowledge of anatomy, otherwise you will get a "one size fits all" approach.Good luck,Nirmal R. Nathan, M.D.
  
Certified, American Board of Plastic Surgery
  
Member, American Society of Plastic Surgeons
  
ACGME-Trained Craniofacial Surgeon

Shaun Patel, MD · Answer

The medial eyebrow is probably drooping because the frontalis was injected while treating the glabella. You will need to wait for the Botox to wear off which can take 3-4 months. At that point, your eyebrows will return to their normal position. Any flaring of the eyebrows laterally maybe corrected by injecting a small amount of Botox above the tail of the eyebrow.

Alex Eshaghian, MD, PhD · Answer

Thank you for your question and for sharing your photographs bcn86. I understand your concern. Botox is a purified protein used to address wrinkles associated with facial expression. When injected into the skin Botox will relax the muscles and smoothen out the overlying wrinkles. The most common areas of treatment are in the upper face. These include the horizontal lines seen on the upper forehead when one raises the brows, the vertical lines seen between the brows when one frowns (frown lines), and the crow's feet seen around the eyes when one smiles.
It is difficult to make an assessment without knowing the dose used and the exact placement of the product. However, I hope the information provided here is useful.The appearance of frown lines is variable from person to person. Usually they are in a vertical orientation but sometimes they can be oblique and sometimes a horizontal line is seen across the upper portion of the nasal bridge. The most common variation is to have two parallel lines, hence the common term "11's" to describe them. But some people have one, three, or more lines. Some people also will see a bulge in the area when contracting the muscle. This bulge is smoothened out after a Botox treatment.
The pivotal studies used 20 units of Botox in the glabella area between the brow to address the frown lines and 24 units of Botox (12 units per side) to address the crow’s feet. These studies demonstrated that the peak results are seen 14 days after the treatment and most people enjoy their results for 3-4 months. At that point, a maintenance treatment is recommended. While some people start to see results as early as the next day, it can take two weeks for full results so patience is important. We have our patients return two weeks after their treatment to assess their results via photographs. At that time additional units may be added if necessary. When patients present with concerns about specific wrinkles in the upper face such as the frown lines, I always assess and usually treat the other wrinkles in the upper face including the horizontal forehead wrinkles and crow’s feet. The reason is to maintain a harmonious and natural balance to the appearance of the upper face. The muscles in the glabella which are responsible for the formation of the frown lines serve to pull down on the inner brows when a person frowns. Similarly, the muscles around the eyes which are responsible for the formation of the crow’s feet seen when smiling (orbicularis oculi) are also responsible for pulling down on the brows, but in this case the outer brows. On the other hand, the muscle in the upper forehead which is responsible for the formation of the horizontal forehead wrinkles when a person raises the brows (frontalis) serves to pull the brows upward. If one of these muscles is relaxed with Botox and the others are not, the other muscles will still be active. This will lead to an unbalanced and unnatural appearance of the upper face where the brow can be elevated, depressed, or uneven in shape or position. Therefore, I recommend that my patients take a global approach to the upper face when receiving Botox treatments and treat all three of these areas. Sometimes bunny lines on the bridge of the nose are also treated.
It is difficult to make an assessment and recommendation without knowing where the product was placed and how much was used. However, if I had a patient with the concern described here I would suspect that the upper forehead and possibly glabella were treated, but the crow's feet area was not treated, in which case I would recommend treating the crow's feet as described above.With any injection, there are risks such as pain, bleeding, bruising, redness, swelling, tenderness, and infection. We take special precautions to minimize these risks such as using a painless technique. We also treat bruises with a laser as early as the next day. Bruises usually resolve within two weeks if untreated. After a laser treatment bruises usually resolve in 1-3 days, but may still take two weeks for full resolution. In addition to these risks, with Botox there is also a risk that the product spreads or diffuses to nearby structures. Spread to nearby muscles can lead to side effects such as the temporary appearance of droopy eyelids or a temporary asymmetric smile.
  
After a Botox treatment, I recommend that my patients avoid heat exposure, alcohol consumption, and strenuous exercise for 24 hours and not lie down flat for four hours. This is because all of these activities may possibly lead to the movement of the product and consequent side effects such as droopy eyelids. Although there have been no definitive studies shown that these actually occur and some physicians do not provide such aftercare instructions, in the absence of data I err on the side of caution and recommend that my patients avoid such activities.
  
Please consult with a doctor for specific recommendations. Good luck!

Maha S. Shakir, MD, FACS · Answer

Dear BCN86,
Thank you for the question. Botox result usually last for 3-6 months. Drooping in the inner eye brow, means you were injected in the Frontalis muscle which is the muscle in the forehead (that is the opposite to brow lift). Make sure to mention that to your injector on your next visit to avoid that.
Best of luck,
LOVA - Lake Oswego Vein and Aesthetic

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