Why does botox drop brow, making lids look puffy? (Photo)

Question

Hi I've had botox a few times in the past and it always gave a lift to forehead. I've naturally heavy lids low brow, full and puffy since a kid but botox has since made my brow drop low each time instead of lifting it. Before I get again, what's the best area to inject to achieve forehead lift? I've been told don't need blepharoplasty as lids have no skin just puffy full. Also it's one eye that goes really puffy

Kenneth D. Steinsapir, MD · Answer

There really is no good clinical evidence that one botulinum toxin spreads more than another. This is a type of whisper campaign that one company does to another. It is repeated by doctors who should know better but they really don’t. You current treatment is freezing your frontalis muscle, the main lifted of your eyebrows. This is not helping you aesthetically. I recommend studying the video I am attaching below and my Microdroplet Lift website. This is a patented method that concentrated Botulinum toxin in the eyebrow depressors and leaves the frontalis muscles untreated. You get a natural eyebrow lift without the freeze.

John M. Hilinski, MD · Answer

This is actually quite common when someone injects Botox to the forehead region and does not try to target the muscles pulling the brow down. Take a look at our website that explains this in detail.

Kenneth Hughes, MD · Answer

Hello, thank you for your question. Excessive Botox to the forehead leads to brow drooping; Botox too close to the eyelid elevator muscle causes the lid to droop.  Both problems would resolve over time.   Knowledge of the effect of Botox and specific anatomy of the face help prevent this.  I recommend you to go to a plastic surgeon's or dermatologists office.

Camille Cash, MD · Answer

The issues that you describe are why it is so important to visit with an experienced injector.  There are certain areas that when injected may improve lines on the forehead but could soften the ability of the brows to raise leading to the dropped brow that concerns you.  Your injector can take precautions to avoid the areas that lower the brow.

Robert W. Sheffield, MD · Answer

When Botox is chosen to treat the forehead and do the eyebrow lift, we look for the opposite. On occasions, when it is not injected in a specific area or the amount of product used is not the correct one, situations like this happen. Your brow dropping and puffiness are temporary side effects; however, they can be easily prevented. Ensure your injector has a lot of experience in the field and does a deep examination of your anatomy; by making this, side effects like yours can be prevented.

Dean P. Kane, MD, FACS · Answer

Dear Forgetmenot27,
Thanks for sharing your photo.
  
While a in-person consult is necessary, base on what I see, you would be best served with a upper eyelid blepharoplasty.
  
The reason for puffiness of the eyelids following Botox or any other injectable muscle relaxer is that the same muscle which relaxes the eye area, the orbicularis oculi muscle also squeezes out the puffy upper lid.
  
So relaxation of these muscle fibers closer to the inside of the eye will allow the eyebrow to drop and the inner eyelid to puff up.
  
The use of micro-dosing the proper muscles is a advanced technique. Please seek out a highly experienced, Board Certified Plastic or well qualified injector.
  
I wish you the best!

Sheryl D. Clark, MD, FAAD · Answer

Dear forgetmenot27:You have been injected with BTX-A in a manner that has allowed the BTX-A to spread to your frontalis muscles rather than being confined to the muscles of the glabellar complex. Patients with eyelids such as yours need to be injected with a very concentrated form of BTX-A, ie not the typical 2.5 ml dilution, but only 1 cc of nonpreserved saline per 100 unit vial, and the injection points need to be close to the brows rather than higher up. You should have #Jeuveau or #Botox, not #Dysport, which spreads more.I hope this helps!Sheryl Clark MD FAAD

Rita Rakus, MBBS - Account Suspended · Answer

Hello and thank you for your question. From your question we can advise here but nothing would compare to a face to face consultation in clinic for an accurate plan of what would work best. the best areas to inject for a brow lift are the frown and the crows feet area muscle. I would seek the opinion of a trusted and reputable plastic surgeon to help with the upper eyelids as there may be a surgical option available to you. Hope this helps, Best wishes

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