Eye shape after Botox. (photo)

Botox injections can be tricky and even in the best of hands there are times when things don't look quite exactly the way you would like them to.  This is where an expert injector can often help make corrections.  I would strongly suggest seeing a physician who is highly experienced with Botox injection.  

Thank you for the great question and for sharing the photo. It looks like your medial right brow has dropped a little bit. This is caused by Botox weakening the frontalis muscle, which is an unintended consequence of using Botox to treat the frown lines between the brow.The frontalis muscle is a brow elevating muscle and, when weak, tends to allow the brow to drop slightly. In most cases, this will only last a few weeks. However, in the worse case scenario, this issue will last 3-4 months - the same as the duration of effect of Botox. Either way, rest assured knowing that this problem is temporary and will resolve on it's own. Good luck!Dr. Harmych

When your eyelids are heavy to begin with, overwriting the forehead lines (frontal muscle) with Botox can drop the brow and make the upper lid even heavier. Unfortunately you have to wait until the treatment wears off in a few months. 

Hi Stellabit,Your droopiness should improve in time as the effect of Botox wears off. I would not inject more Botox to try to raise the eyebrows as while injecting more botox may raise the eyebrows, it can at the same time lower your eyelids even more.  If you can see an ophthalmologist, they could prescribe a drop by the name of Iopidine for you which temporarily helps with your situation while waiting for the effect of the Botox to wear off.     

Eyebrow ptosis (drooping) after Botox is not very common. Unfortunately your Botox has affected your frontalis muscle (the forehead muscle that raises your eyebrow) and is allowing gravity to pull your right eyebrow down. Further injection above the arch is not effective in my experience (as injections there will only exacerbate the frontalis paralysis). I have found that massage of the forehead area on the affected side may hurry the resolution of the muscle paralysis. It usually takes about a week or two so try and be patient.Best of luck,Dr K

Give it a little time and it should improve.  An experienced injector is able to lift the brows with injections sometimes.  This is usually a problem with either too much Botox used in the forehead or improper placement.

Hello and thank you for your question. There are many factors that may be playing into what you are experiencing: 1) everyone has asymmetry to some degree as the two halves of the face have been proven not to be identical. It is possible that you had pre-existing asymmetry and did not notice it as much until after your procedure; this is unlikely however given that you have had botox before and were happy. 2) facial aging: the eyelids in some people get heavier due to excess fat and/or skin; it is possible that even subtle changes with aging can cause a different appearance with botox3) it is also very possible that the Botox you had injected dispersed or was at a different dilution than before. You did the right thing by going back to the place where you had this done and I respect them for trying to rectify itbottom line is that you will have to wait now for the Botox to wear off if it indeed was from your injection or if you are unhappy with the results. It is harder to assess your situation without pre procedure photos. I think it does not hurt as a second opinion for you to go to a plastic surgeon who has great knowledge of the facial anatomy and bring pre procedure photos and also those from when you were 10-20 years younger to assess your candidacy for continued Botox vs if you need a blepharoplasty or other concomitant therapies. I hope this helps!

Hi,Did they treat your forehead as well?  When treating the frown area with Botox it is very unusual for there to be eye asymmetry.  My guess is they treated your forehead and your right eyebrow dropped a little, which is not uncommon.  They then tried to put a little under your arch to raise it a bit.  At this point I would leave it alone and often the dropped eyebrow will correct it self after 4-6 weeks and in the worst case scenario after 3 months. Consider in the future doing Botox to your frown and eyes and leaving your forehead alone.  Those two area make stuff go north and north is good...Good luck

One of the more difficult things I do in my practice is assessing patients properly after Botox treatments that have less-than-perfect results. First thing is first, and that is creating the right diagnosis.This requires assessing each of the muscles of facial expression involved around the eyes and in the forehead as well as understanding which muscles have been affected by the Botox and which ones haven't. Then we can begin to get an understanding of, first, what the problem is and, second, if it's possible to correct it.To me, it appears some Botox treated you right from frontalis muscle. This is the main muscle in the central forehead used to race your brow.You could consider posting two pictures, the first of you in a relaxed state and the second contracting your facial muscles.With time, this will all resolve.Ask your provider to see if they can give a clear explanation of what happened. If not, perhaps consider a second opinion elsewhere.Best of luck,Mats Hagstrom, M.D.

The paralytics- Botox, Dysport etc., all have a risk of causing too much sagging of the upper eyebrows which results in the manifestation of the excess eyelid skin.  The eye brow asymmetry will go away when the paralytic wears off.  This is a risk of the injection and it does not mean the doctor did something wrong it just means that the paralytic extended more laterally than you are used to.  Few people will notice the problem as much as you do.  It is likely that if the injection was done by the same person, they injected in almost the same place as always so the lateral droop may be from some that has leaked to the side more than normal which means it may not be as strong a paralytic as the rest of the treatment areas, so it may resolve quicker.  Looking at your eyelids, you have so much excess skin, you would benefit from upper eyelid skin removal which is called a blepharoplasty.  This need is frequently made more visible by the paralytic because your natural tendency to lift the brows subconsciously in order to get the excess skin off your lid is not functioning with the paralytic on board.  The weight of the excess eyelid skin is part of the reason you have presented for the paralytic in the first place because with out the excess skin you would not lift your brows which has caused the wrinkles.  This is a wonderful surgery and done as a straight local procedure.  Sutures are removed in 3-4 days and the results last for many years. Having this procedure will reduce your need for the paralytic and make your eyelids look better with and without the paralytic on board. Good luck- just wait it out- it is still worth the paralytic cuz the wrinkles look much worse.