Why did my inner eyes point down after Botox? (Photo)

Question

I got 30 units around my forehead and crows feet. It's been just over 2 wks and I noticed my inner eyes have pointed down slightly. It feels heavy between my eyes. My eyebrow arch looks higher due to the drop between my eyes (specially my right eye). Its made me look tired and mean and very self conscious. What went wrong?

Pure Aesthetics - Gainesville · Answer

This is relatively common, especially when having Botox done for the first time by someone. It is usually related to muscle recruitment, meaning the forehead is not entirely relaxed on the outer edges and then they pull up the eyebrows as a result. The forehead (frontalis) is the only elevator muscle on the face, so practitioners generally go a little more conservative on the outer edges, as those are the areas that can drop the eyebrows if treated too aggressively. I usually have people come back a few weeks later just to tweak the initial injections. I think you could get complete correction with 1 or 2 units placed directly above the peaked areas. Hope this helps!

Chase Lay, MD · Answer

I see what you are talking about but do not worry.  It can be helped.  Sometimes when inject crows feet, the depressor function of the orbicular muscle is relaxed which makes the competing forehead muscle lift brow.  You can add a little more Botox to the lateral part of the forehead to reduce the peak of your lateral eyebrows.  Also, since you treated the forehead but not the frown lines of the glabella this may be now pulling down not he brow since the forehead is relaxed in the middle of the forehead.  So, touch up the lateral forehead and maybe treat the frown line to give better balance.  This is a common issue and it can be improved.  Sometimes using Botox or Dysport can be a little bit of a learning experience for the patient.  Not everyone is injected the same.

Michael H. Gold, MD · Answer

Thanks for the question and the photos and sorry that you are having these issues after your Botox injections.  We always recommend that you have these done in the offices of board certified dermatologists or plastic surgeons.  Your lateral brows are up somewhat and these can be corrected with some more toxin placed by an expert who can correct this.  If there is slight downward shift in the inner eye areas, these will go away as the Botox wears off, but this seems minimal in the photos.  I would go back to your injector and see what the best options are for you.

Shaun Patel, MD · Answer

If too much Botox is used in the central frontalis or the Botox is injected too high into the glabella, the medial eyebrows can appear droopy. This can sometimes be corrected by injecting additional Botox into the eyebrow depressors such as the depressor supercilli. I would follow up with your injector to discuss your concerns.

Jo Herzog, MD · Answer

I do not appreciate that your eyes are pointing down more. However, you do have a little drop of your brow it the upper photo is the before. The amount you had injected seems very reasonable but the doctor might need to change your injection pattern a little next time as everyone reacts differently and you don't always  know what you will like until you try it . Nothing went wrong, just need a little differently next time

Steven F. Weiner, MD · Answer

If the Botox is not placed properly, the medial brows can drop. This can sometimes be fixed with more Botox in the depressor supercilii. The central portion of the frontalis muscle has been treated to heavily and this is what can happen in some people.

Leonard Grossman, MD · Answer

i would urge you to find same kind of a photo but before the treatment. Chances are the corners of your eyes were just the same. 
Good luck from NYC

Lisa Vuich, MD · Answer

It sounds like your glabellar complex (between the brows) was not injected. Since the forehead muscles have relaxed, the glabellar group is now to dominant. The lateral peak ('Spock brow, technical term Mephisto effect) is due to the central forehead muscle fibers being relaxed while those on the sides are still active. Overall this result can be improved with additional botox.
Best,
Lisa Vuich, MD

Amit Gupta, MD - Account Suspended · Answer

Hello
As i see as per your pics, you have 2 major issues, and more on the right side.You have ptosis induced by botox. This is eyelid falling down due to effects of botox on deep eye muscles, This is an unintended side effect , and is temporary, will go away in less than 3 months. The other problem is with the right eye brow. There is an imbalance between your eyebrow depressor and elevators. Your doctor has weakened the depressors, without suitably weakening the elevator, thus giving a field day to the elevtrors. A simple solution will be inject 2 units of botox on the elevators to weaken them, Your eye brows will improve a lot.

Why did my inner eyes point down after Botox? (Photo)

Answers (9)

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