What Else Can I Do If I Had Unsuccessful Botox Brow Lift? (photo)

Question

After reading your advice in another question I decided to first try Botox for lifting my brows because of the heaviness I was feeling on my eyes (also because of deep set eyes?). I had it 8 days ago and I am very disappointed. I felt slight numbness for 2 days but that's it. I am still able to move my brows down and do everything I was able to do before. Is it possible that my body just doesn't respond to it? I know you don't recommend a surgical lift at age 23, but do I have any other option?

Young R. Cho, MD, PhD · Answer

Thank you for your question.  Shaping the brows is one my favorite parts of using Botox.  It requires a very detailed understanding of the underlying anatomy as well as assessing each individual while they are animating their brows.  By carefully placing Botox in the muscles that depress the brow, you can cause the brow to rest and relax in a lifted position.  There are limits to how much you can lift, and for some surgery is better option.  Incorrect assessment or placement can also lead to the reverse effect, so overall technique is critical.  You can also shape the brow different.  For example, you can raise the tail of the brow vs creating a raised arched brow vs creating a raised horizontal brow.  It depends on the individual's desired brow aesthetic goals. I would consider this a very advanced technique so I would query your injector on their experience in this area.  
As far as how many units may be needed, this also depends on which part of the brow you want to correct.  For the inner brows, you may consider ~20 units (same as the frown line treatment).  For the middle or outer brow, I generally use up to 5 units on each side.  
You may also want to consider adding fillers to shape and raise the brow.  Combining the two products can work synergistically together. If you can still lower your brows easily, then you can consider additional Botox to weaken the brow depressor muscles.  Ultimately, surgery will provide you with the look that you are looking for.

A.J. Amadi, MD · Answer

Unfortunately, the only way to get your brows to achieve the arch that you are demonstrating in your third photo, is via a surgical browlift.

	A trichophytic [hairline] approach will give you the most reliable long lasting result.

Barry L. Eppley, MD, DMD · Answer

What you have proven with Botox is that a non-surgical approach is not enough to lift your brows adequately. It is now time to consider some form of a surgical browlift and you should get several consultations to learn your options.

Dominic Bray, MBBS, FRCS · Answer

Thermage CPT may aid your lift a little but your brow is rather heavy for your years. This is most marked in the lateral aspect as shown by your third photo. The medial brow position is good so if you would consider surgery I would suggest a temporal (lateral) browlift under pure local anaesthetic.

	I think that would give you a pleasing and more youthful brow postion.

	Kind regards

Darryl J. Blinski, MD · Answer

I might try a second session with BOTOX injections to the sub eyebrow area. You may need additional BOTOX units.

Lorne M. Tarshis, MD (retired) · Answer

Browlift surgery can do two things. It can rejuvenate a sagging brow in an older person or GLAMORIZE an eye in a younger person when the brow is developmentally low. Botox browlifts have definite limitations. An endoscopic browlift to lift the outer third of your brow is a minimally invasive procedure which would definitely improve the 'frame' of your eye which is determined by the height of the brow above and the prominence of the cheek below. You should consider this.

Richard W. Fleming, MD (retired) · Answer

Rarely do Botox injections adequately lift brows as low as yours. A surgical brow lift is appropriate regardless of age, whether the patient is young like you with inherited low brows or in an older individual whose brows have fallen with time. Years ago we developed the Irregular Trichophytic Hairline Brow lift where hair follicles buried under the hairline incision grow through and in front of the hairline so the scar will not be seen. This approach would also enable us to lower your hairline and decrease the height of your long forehead.

Thomas A. Narsete, MD (retired) · Answer

After 8 days, you have not given the treatment enough time to see the results. In my experience, the botox takes a few weeks to work and lasts for several months. Botox only does 1 thing, it weakens the muscle you inject it into. In my experience, you can adjust the eyebrows with it. Sometimes a small touch up can help. Discuss this with your doctor.

Francis R. Palmer, III, MD (retired) · Answer

Aesthetically speaking, regardless that you are 23, the eyebrows are very low in the photo provided.  Botox is a reasonable non-surgical method of lifting the brows but it does have limits to what it can do.  You might want to have a consultation with a plastic & cosmetic surgeon regarding a Brow Lift....which is the only way your Eyebrows will be raised to their aesthetic ideal position.

	 I learned many years ago...not to treat the age of a patient but the aesthetic indications that they present.

What Else Can I Do If I Had Unsuccessful Botox Brow Lift? (photo)

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