Thank you for your question.
You’re concerned about your brows being uneven after Botox® and you state that the
lower brow is the side which has a prosthetic eye.
And you submitted photos with your face at rest and then with elevation of your brow.
And it becomes more clear with one photo that the right brow goes up and the left brow does
not and you want to know how to fix the left brow.
Well, I can certainly share with you my approach to helping patients with Botox®.
A little bit of background, I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial
plastic and reconstructive surgeon.
I have been in practice in Manhattan and Long Island for over 20 years.
And I have been treating patients with Botox® since 1993.
Our specialty was amongst the first group of doctors to use Botox® and really, the
world has expanded so much with many uses of Botox®.
So to basically go over the physiology and basis of what you’re experiencing, essentially
to deal with what’s generally forehead wrinkles, there’s a muscle called the frontalis muscle
and this muscle has a vertical orientation.
When this muscle is engaged, the eyebrows go up.
Very often, when people have a certain habit or with aging as well as some situations where
their eyelids are drooping, they use that muscle a lot.
And so, a strategic placement of Botox® can help reduce the lines.
Some people prefer no muscle activity on the forehead so they have a very smooth forehead.
Now one of the consequences of that is that the brows can droop.
Now, judging by the photo, it appears that you just have some residual activity on the
right side and no activity on the left side which is the explanation as to why the left
brow doesn’t come up at all.
The unfortunate reality is that you cannot reverse Botox®.
This requires essentially time to let the Botox® wear off on that side so that the
brow comes back up.
Now every doctor who does Botox®, I’m sure can relate to this type of situation because
dosing is something that can have very variable impact even though you know the patient for
a long time.
But I would say that it is advisable to bring this to your doctor’s attention.
So if this is the doctor you’re going to regularly, the doctor will know to adjust
the dosing and placement for next time.
In our practice, when we do Botox® whether it’s for wrinkles around the eyes, for frown
lines, forehead, for lip lift or chin dimples.
I mean there are many uses of Botox®.
We have patients come back after about 2 weeks to assess the effect and to see if we need
to enhance or at least document what is the optimal dosage and placement for that patient.
And that’s an important thing that hopefully you have in your situation.
I think that if your concern is mostly about symmetry, then one could consider additional
Botox® over the right brow so that the right brow comes a little lower.
Now, that may not be desirable because you may feel that the brows are too low.
And if your eyebrows are much too low, then you’re not going to like that either.
So I think it’s very important for you to discuss this with your doctor.
Review the dosage, review the amount and just allow some time to pass.
The Botox® will wear off and then you can allow for the next time for maybe more conservative
treatment on that left side.
I always tell my patients it’s better that you come back in two weeks so I can add because
I can’t subtract with Botox® .
So I hope that was helpful, I wish you the best of luck and thank you for your question.