Uneven Eyebrows After Botox?

Asymmetry happens even with the most experienced providers. It may be as a result of different reasons, but if one eyebrow is more elevated than the other, depending on the anatomy and the location of the wrinkles, the side that's elevated might be relaxed more by adding 1 or 2 units above the area. Some times, though, it is too close to the eyebrow and rather than risking a brow droop along with the eyelid, the other side might be raised more to make it symmetric with the other side.

The evaluation should be done in-person to examine the individual with different expressions, and then it can be determined which is the best course of treatment.

The information provided in Dr. Shelton's answer is for educational purposes only and is not intended to constitute medical advice.  The information provided should not be relied upon as a substitute for consultations with a qualified health professional who may be familiar with your individual medical needs.

Asymmetry can occur with botox, and the way it was handled is in keeping with what most would do.  I would give it 2 weeks to take full effect. If you're still unhappy, visit your plastic surgeon for correction. Good luck! 

Dear Mayfly,

Everyone's eyebrows are slightly uneven to begin with.  The best way to confirm that is with a picture with your face relaxed and the eyes closed.  That being said, if the Right brow is too elevated from too much muscle movement in the forehead, that can easily be corrected by added 1-2 units of Botox to further relax that forehead muscle.  If the forehead muscles on the Left were overly injected and too relaxed, then that brow will be lower and there's not much to do but wait a bit.  It sounds like your doctor tried injecting the muscles pulling down the left brow near the tail of the brow to get that brow to go higher.  That may not always work; but it's worth a try.  Best of luck.

It's very difficult to answer your question without seeing you in person, however if your brows are now symmetrical after your recent follow up and you're happy then that's your answer. It's not clear why the left side was touched up rather than the right.

Thank you for your question mayfly. 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 in the absence of consistent photographs before and after in the same lighting and angles for comparison. 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.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.When Botox is used in the upper forehead, if the dose is too high or the placement is too low it can result in the feeling of heaviness in the eyebrow or even lower the position of the brow. In order to reduce the risk of this possibility, I use a conservative dose in the area and place the product high on the forehead, sometimes near the hair line. Additionally, I recommend that my patients simultaneously receive a small amount Botox between the brows and at the corners of the brows. This will relax the muscles that pull down on the brows to counteract this effect and provide a harmonious balance to the position of the brow. The results are assessed two weeks after the treatment. If there is any asymmetry a small amount of Botox can be placed in the upper face for correction.Sometimes after a Botox treatment a peaked appearance of the eyebrow is seen. This is sometimes called the Spock or Mephisto look, which makes a person appear surprised or sinister. It is also called the Jack Nicholson look, after the appearance of his eyebrows. This can occur if the muscles that pull the eyebrow down are relaxed with Botox. It can also occur if the upper forehead only is treated. In this case the inner portions of the muscles are relaxed preferentially over the outer portions of the muscle. This allows the outer portions of the muscle to pull up on the tail of the eyebrow. While some people desire this appearance, others do not. This effect can be corrected by placing a small amount (1-2 units) of Botox in the upper forehead approximately midway between the eyebrow and the hair line at the peak of the brow. This relaxes the muscle that pulls up on the tail of the eyebrow, thereby restoring a natural appearance.If I had a patient with the concern described here I would like to first assess the before and after photographs. Without this information I would say the course of action described here is appropriate.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!

Asymmetry can occur with the injection of Botox into the forehead.  The good news is that it is typically easily resolved with appropriate placement of small amounts of product to resolve the issue.  I would recommend giving the latest injections a full two weeks to work and then return to your plastic surgeon if you are still unhappy with the appearance of your forehead.

 Best Regards,

Jacque P. LeBeau, MD

Your PS injected your left brow to try to raise it.  Wait 2 weeks and if your right eyebrow is still higher, return to the PS who will inject a small amount of Botox above your right eyebrow to even your brows.

Injecting a couple of units 2 weeks after treatment is appropriate for correcting asymmetry from the treatment.  Your PS was attempting to raise your left brow to match the height of the right.  However, from what you write, it sounds as though the problem is that your left brow does not raise as high as your right but they are even at rest, so the treatment to even them out would be to place a little Botox in the right side of your forehead to limit the amount your right brow raises.

You are describing asymmetry that may occur after administration of Botox. correction should be done at two weeks after initial injection. The treatment to the left brow is done to help raise the lateral portion of the brow. If you still have strong muscle activity of the frontalis muscle on the right side it maybe advised to add Botox to the area with that activity on the right forehead.

 

Best of Luck!!!

  

The left/right discussion has me a bit confused, and usually when a patient calls, we just need to see them to evaluate.  If one brow is raised when the forehead is at rest it usually takes a couple of units in that pleated muscle over the raised brow to bring it back down.  If it raises higher when the forehead is in motion it may require some balancing of not only the frontalis muscle(forehead)on both sides but can also result in balancing the dynamics of the brow depressors as well.   One look is worth a thousand words.  Go back and let them assess and balance it out.  I personally always do that at no charge if it happens.