Eyebrow Droop After Botox? (photo)

Question

I just went to the doctor and got my injection sites from her. I am 37 years old and was injected in July at 4 sites at the top of my forehead and in my eyebrows as well as the crow feet area. I was injected more than 2.5 units. In November I was injected the same places just no more than 2.5 units. It looks like she has been consistently injecting my eyebrows. Will this cause my brows to remain droopy even after the Botox wears off since it has been 2 years? Brow ptosis first began around Sept and has gotten much worse after Nov injections. Thanks.

Mark K. Markarian, MD, MSPH, FACS · Answer

First off, thank you for the pictures.The short answer to your question is NO -- your brows should return to their injection state once the Botox wears off completely, typically after 3-4 months.That being said, your question warrants discussion of this important complication of Botox -- eye-BROW droop...A drooping eye-BROW may happen in the following scenarios:(1) When the brow-elevating muscle in the forehead, the Frontalis, receives too high a dose of Botox.(2) The Botox is sub-optimally placed too low in the forehead -- it should typically be placed at least 1 cm above the Brow. (3) Over-injection of the glabella area (between the brows). (4) It may also happen if you have a low set eyebrow to begin with, in which case any Botox to the Frontalis increases the likelihood of a brow droop. Ironically, a droopy eye-BROW from Botox can sometimes be improved with MORE Botox -- this time, the Botox is typically injected into the outside (top of the crow's feet) part of the eye (aka the lateral aspect of the orbicularis oculi muscle) to generate a bit of a brow lift in that area -- by injecting more Botox and paralyzing the orbicularis muscle that normally acts to depress the brow in that area, you may get a slight compensatory brow lift...If the extra Botox does not improve the brow droop, it will likely last as long as the full duration of the Botox -- 3-4 months.Please seek the services of an experienced physician injector. I think the key with Botox lies in truly understanding the anatomy of the injected area, and more importantly the variability in the anatomy between patients -- for brows, the forehead, and anywhere else you plan on receiving a Botox injection. This includes having a firm understanding of the origin, insertion, and action of each muscle that will be injected, the thickness of each muscle targeted, how deep beneath the skin the actual muscle resides, and the patient variability therein. As an aesthetic-trained plastic surgeon, I am intrinsically biased since I operate in the area for browlifts and facelifts, and have a unique perspective to the muscle anatomy since I commonly dissect under the skin, see the actual muscles themselves, and learn "first-hand" the incredible variability between patients -- live, "on the OR table" -- as opposed to via lectures or a cadaver dissection. For me, this helps guide where to inject and where not to. However, with that said, I know many non-aesthetic trained plastic surgeons and other physicians who know the anatomy well despite not operating in that area, and get good results.Good luck.Dr Markarian

Melissa Chiang, MD, FAAD · Answer

Botox injected into the forehead can result in brows falling.  The effect of botox will always wear off completely.  The ptosis that you have noticed may be the effect of the natural aging process.

Kenneth Hughes, MD · Answer

Botox can be administered for forehead lines high enough on the forehead to have an effect without compromising brow position.

Sam Naficy, MD, FACS · Answer

Botox wears off in ~3 months, so no, it can't cause brow ptosis long term. It's a little confusing, your description of treatment, however in the short-term, improperly injected Botox to the forehead or brow area can cause ptosis of the eyelid or brow.

Robert F. Centeno, MD, FACS · Answer

Thank you for your question and for sharing photos.  The good news is that once your botox wears off, things will go back to their normal state.  You will not be worse off than you were before.  Brow ptosis after botox is a result of the injection technique.  Botox can be used very effectively to shap the eyebrows by elevating them.  I would recommend you discuss your concerns further with your doctor or consult with another expert injector to get you the results you desire.  Unfortunaltely you will need to wait until some of the existing botox wears off until you can be re-treated.  Best wishes.

Ellen A. Mahony, MD · Answer

The good news is that Botox does not last forever.  Whenever you decide to discontinue using it, your brow position should return to it's natural position.

	Thanks for asking!  Dr Ellen

Harold J. Kaplan, MD · Answer

Hi SP.  Difficult to tell from the pictures where the concern is although it looks like you have the eyes open in one picture and closed in the other.  

	If you do have droopiness of the brow related to the injections, this will wear off in a couple months.  Speak with your practitioner about it and let the product wear off fully so you can have a baseline picture again.

Michael I. Echavez, MD · Answer

If you allow the Botox to wear off completely, you should have normal movement of your eyebrows. I am a little unclear exactly where you were injected into your eyebrows though, and for what purpose. Injecting above the eyebrow would normally cause the eyebrow to fall, while injecting below the eyebrow can help the eyebrow to raise.

Jeffrey Zwiren, MD · Answer

The corragator muscle is interwoven with the frontalis muscle. The corragator muscle creates the vertical glabellar creases and this muscle is a depressor of the inner aspect of the brow so this muscle will cause an elevation of the medial brow. If the injection is performed too high or if the Botox spreads superiorly then the frontalis muscle can be effected and this causes the brow to drop. This effect should wear off in 3 - 4 months.

Benjamin Barankin, MD, FRCPC · Answer

Botox is typically injected in the upper one-third of the forehead to try and minimize the risk of a brow drop which is more common in people older than 50. Injecting the correct amount, at the right depth and placement, you should have no problems - see a highly trained and experienced physician for optimal results and safety (e.g. dermatologist or plastic surgeon).

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