11 days post Botox: developed high, "Spock" brows. I went back for more to lower the brows, I've got hooded lids, what do I do?

Question

I told the injector I had a history of Botox brow drop, so he injected my 11's and high on my forehead only. By 2 days later, I had the "Spock" brows. I was told to wait a full week, and come back. I did, and he injected, what seemed like a lot, into my upper outer brow area. My brows dropped, so did the area below my brow. I now have droopy skin folds hanging down on my upper lid, and and a heavy, hooded eye look. I look older than before. Can this be corrected with more Botox?

Nelson Castillo, MD · Answer

Thank you for sharing your excellent question.  A problem with patients who use their forehead to "lift" their eyebrows this sagging can be counter acted with Botox placed into the upper outer crow's feet.  Eye drops will not improve eyebrow ptosis, these only address eyelid sagging.  Hope this helps.

Jason Emer, MD · Answer

This is difficult to answer without pictures. Botox results last 3-4 months. In the mean time, venus legacy and thermage treatments can soften results. Best, Dr. Emer

Philip K. Robb Jr., MD, FACS · Answer

Thanks for your question, 
You seem like a well educated botox patient which is great. Our face has about 50 muscles in it. Each pull the tissues in a certain way. When using Botox, we selectively weaken certain muscles. When all of the brow elevators are weakened, the result in brow fall (or ptosis of the brow). The upper eyelids can also be affected if the injector is not careful. 
The only thing that Botox can do is attempt to weaken some of the brow depressors (which can be done) to allow the brow to raise slightly. 
Option #2 is wait. This could take anywhere from 2weeks to 3-4 months to resolve. 
Option #3 is to have the excess eyelid skin removed. Upper lid blepharoplasty is performed occasionally when someone gets brow drop that causes excess skin and heaviness on the upper eyelids. It's important to understand that this is a permanent solution to a temporary problem but many patients just can't stand the heaviness and this does help that. 
Hope this helps and God Bless!
Dr. Robb

Frank P. Albino, MD · Answer

Eyebrow ptosis or "drop" is a known potential with Botox and also one that is difficult to manage.  You may consider going back to your provider to see if you would benefit from a small amount of Botox under the eyebrow to the side in the muscle to help provide a small lift.  Based on what you wrote, this may have already been done.  If so, there is not much more Botox will provide for you. Keep in mind that it is temporary and that there are drops that may partially reverse some of the effects of Botox- ask your provider about these. On occasion the forehead muscles can mask a low eyelid by working to lift the eyebrow and eyelid. Botox can then weaken this muscle and expose eyelid "droop."  As your plastic surgeon if this is a possibility for what happened in this case. Not everyone is a good candidate for this treatment so please see a Board Certified or Board Eligible Plastic Surgeon to evaluate if you may benefit. Good luck!
  
This content is for educational and informational purposes only. It is not a substitute for medical advice, diagnosis, or treatment provided by a qualified healthcare professional.  You should always seek the advice of your physician or healthcare professional for any questions you have about your own medical condition.

Lisa Kates, MD · Answer

Thank you for sharing.  Very sorry to hear about your unfortunate side effect.  This is really a case of less is more.  Injecting too much Botox into the lateral portion of the frontalis muscle or close to the brow can cause lid hooding.  When you experienced the "spock" effect, very small amounts should have been used to correct it.  Now that you have the heavy brow, it is best to be patient and wait for the effects to subside.

Christopher Manios, MD · Answer

Thanks for your question smartpantsme
This is a common issue among some practices. The issue is there wasn't enough botox given across your whole forehead. Instead it seems that the botox was injected more centrally resulting in a overstimulation of the muscle in the areas that were not addressed. When patients present with this issue, injectors may be overly zealous in addressing your concern by placing too much botox in the areas of movement. This can result in a heaviness over the eyes. The best approach I find is to inject the crows feet especially at the corner of brow to help relieve the pressure you are expressing.

Steven F. Weiner, MD · Answer

Taking care a spock brow is done with a very small amount of Botox - 1-2 units total. It is caused by hyperactivity of the lateral frontalis muscles when the more medial fibers are relaxed. Now that you have heavy, hooded brows, the only thing that might help is placement of Botox along the brow and lateral orbital area to release the downward pull by the orbicularis oculi muscle. I don't think this will help too much but it is worth a try.

Beata Danek, MD · Answer

I think that the best at this point is to wait, until Botox wears off. It will start getting better after 2-4 weeks, but full recovery may take 3-4 months. Sounds like you may have both eyebrow and eyelid drop, I definietly suggest to try Iodipine drops. It is also important to take pictures, so you can show it to the doctor who will do your next Botox, if any. I would be very conservative next time, using less units of Botox and following post injection recomendations. Good luck.

Jill C. Fichtel, MD · Answer

"Spock eyebrows" are an undesired side effect of Botox treatments.  This happens when the muscles closer to the central of your forehead are affected more than the ones to the side.  This can be corrected by injecting more Botox on the sides.  However, if a patient is over-injected, it is possible to get "ptosis", or hooded lids, as a side effect.  Some physicians will trial apraclonidine drops to correct this side effect.  However, for most patients, it's best to wait until the effects of the Botox wear off.

Steven Wallach, MD · Answer

It sounds like you had too much botox. The hating skin will not improve for 4-6 months.  Eye drops are only helpful if you have eyelid ptosis an not brow ptosis.

11 days post Botox: developed high, "Spock" brows. I went back for more to lower the brows, I've got hooded lids, what do I do?

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