Will Uneven Botox Results Get Better?

Question

I had Botox 3 weeks ago in between my eyebrows. I was told this would help give my eyes a little lift, since I don't have bad scowl lines in between my eyebrows. My right eye raised more than my left, which looked a little droopier! I went back for my 2 week check.She added 1 cc to my right eye to lower it a little, now it is droopier than it was before Botox! she put 2ccs in the outside corner of my left eyebrow to help the center lift more, but it doesn't look any better!
Is it too soon to tell,? Should both eyes improve?

David Shafer, MD, FACS · Answer

J. Dunn,
This is a good question.  Botox works by paralyzing muscles.  This effect is beneficial to reduce dynamic wrinkles on the forehead, glabella (between the eyebrows) and the crow's feet areas around the eyes.  When Botox is injected the balance between the facial muscles is disrupted.  This is advantageous for people who need to correct brow position.  By injecting Botox under the brow, the orbicularis occuli muscles around the eye are weakened and the later brow raises.  When Botox is injected into the frontalis muscle above the brows, the elevator muscle of the brows are paralyzed and the brow drops.  For most people, a net positive balance is reached and the eyebrow is raised to a better position.  When a negative balance is reached, brow height can be manipulated by injected more Botox either above or below the brows to affect position.  It is best to keep in mind that it takes Botox 3 to 7 days to start working and up to 2 weeks to see the final effect.  So if you are looking for results 1 day after injections, you will not see a difference.
In your question you state that your doctor injected 1 cc and 2 cc of additional Botox.  I assume that you mean 0.1 cc and 0.2 cc, since the values that you stated are way to much Botox if your injector is making minor "touchups."
I hope this is helpful.
David Shafer, MD
Shafer Plastic Surgery
New York City

Raffy Karamanoukian, MD, FACS · Answer

Try to use your muscles more over the next two weeks to re-equalize your eyebrow position and regain your natural look. Surgery90210

Vincent N. Zubowicz, MD · Answer

Botox is great for the area you received your treatment between the eyebrows. After two weeks from the treatment you will have the full effect of the Botox. Everyone has some asymmetry to their face and Botox should be tailor made to your needs. For example you might need a little or less on one side. The great thing about Botox is that if you have a bad result it will go away in 3-4months.

William Ting, MD · Answer

Sometimes certain facial muscle groups require more doses of botulinum toxins. So it is not uncommon to return to your board-certified physician so he or she can make minor adjustment, e.g. booster shots.

Lorrie Klein, MD · Answer

If your results are uneven at 2 weeks or later, which is when the maximum results should be apparent, then an expert injector can usually make you look more even by adding a little Botox to one or the other sides. Muscles in the face are like pulleys which raise and lower eyebrows and other structures. Sometimes we start out with natural asymmetries which can often be corrected with the proper placement of Botox in different amounts to each side of the face. Sometimes an asymmetry can occur from the Botox treatment treatment itself.
If you go to a physician who is very experienced with Botox and with customizing Botox treatments you have a good chance of having your uneven results fixed. Of course, you can always wait for it to wear off also but personally I would want my Botox results to look fantastic for the entire time it was in effect (and I do!)

Harold J. Kaplan, MD · Answer

Without being able to evaluate you directly it's tough to say exactly which technique (or the amount of Botox units) that should be used to correct the situation. In fact, given that you have been injected three times, it may just be better to wait. You have a couple options:

Wait 3-4 months for the product to wear off and find a new and qualified injector to do the work correctly.
Find a new and qualified injector now to see if the results can be fixed.

Anil R. Shah, MD · Answer

The appropriate use of botox is to balance the face not provide further asymmetry. Often times there are preexisting asymmetries which need to be accounted for preinjection. Even so, there are instances at followup when you many need a unit here or there to balance the face further. You may want to give your face a little time before returning to this injector. One of the good things about Botox is that its effects are temporary. If you don't like it, its effects will be gone in a few months. Newer modalities which are being tested are looking at decreasing facial movement for a period of 18 months or more-- which would be quite scary in a situation like yours.

Anthony Perkins, MD · Answer

Thank you for your question!  Botox takes about 2 weeks to stabilize.  I encourage people after injection to use the injected muscles for that day to help improve early onset of Botox function.

	In your case you will see an improvement over the next week.

Kris M. Reddy, MD, FACS · Answer

You should notice the maximum benefit in another week. If asymmetry exists prior to treatment, then it will be quite difficult to achieve perfect and lasting symmetry. Frequent touchups will help.

John P. Di Saia, MD · Answer

Hello,

	 

	The eyebrow lift some say they get with Botox is very inconsistent. I would let the current treatment wear off and consider not having that part of the treatment next time.

	 

	Best Regards,

	 

	John Di Saia MD

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