Thank you for your question.
You've submitted photos and you've described in your history that when you were 15 years
old, you were hit on the right brow with a cricket ball requiring stitches and was very
swollen.
Now you're 27 years old and you’re exploring options to improve your appearance.
You met with a cosmetic surgeon who suggested the use of Botox and so you want to know whether
or not this is of value or whether there are other options available to you.
So I can certainly help you with this question.
I'm a Board-certified cosmetic surgeon and Fellowship-trained oculofacial plastic and
reconstructive surgeon.
So working around the eyes is a very significant part of my practice and I’ve been in practice
for over 20 years in Manhattan and Long Island.
So when I look at your face in the photos you submitted, there are a few things that
I notice but then it is your decision to decide whether or not you feel these are significant.
So when I look at your right brow, I can see an area of scar which doesn't have hair, so
I’m assuming that’s the area that was sutured.
I notice that the eyelid crease on your right side is not as well defined as the left side.
And that the brow is slightly lower on the right side.
So when this colleague mentioned the use of Botox, I think the doctor was probably considering
the ultimate goal of achieving improved symmetry, which means Botox being applied to the left
eye or the left brow area, when I say brow I mean the forehead.
The muscle that lifts the eyebrow is called the frontalis muscle, it's what we call the
brow elevator.
And so if the right brow is low, then putting Botox into the frontalis muscle on the left
side will result in relaxation and dropping of the left brow.
Now that may improve symmetry but I'm not sure you'd be happy or satisfied with that
result, because what I think is important for you is to feel like your eyes are open.
And from that respect, the question then comes back to whether or not there is value in trying
to paralyze the contralateral or opposite muscle to try to create symmetry.
I would also say, just from a practical standpoint, that at this stage of your life it may be
an area that bothers you a lot, but I would be hard pressed to believe that lots of people
notice the droop as opposed to maybe seeing the scar or the relative hooding over the
right upper eyelid.
Just for the sake of completeness, and I'm not necessarily recommending this, in patients
who have had asymmetric eyebrows, where brow lifting was not a practical option, and I
would dissuade you from brow lifting surgery for a variety of reasons, but I would say
that in some patients we just do a right upper eyelid blepharoplasty where we remove a little
bit of skin to create some balance so that the eyes look more open.
Because I think when people look at you, they don't look at your eyebrows, they look at
your eyes, and so that is also an area to explore.
Now since we’re doing this evaluation without the benefit of a physical exam, another way
that Botox can be used is to try to create a little bit of a brow lift, and that's by
relaxing the muscles or the brow depressors.
Now that is possible but I'm not sure, given that this was an injury and there was probably
some stretching, whether or not it would be that effective.
Again, from a practical perspective, I would say that aesthetically I don't think that
it is as significant a feature as it may be to you, because you've gone through this trauma,
but if you have any doubt or question about the first doctor's suggestion, I think it's
important that you meet with other qualified and experienced cosmetic surgeons who can
give you some opinions and guidance based on their experience.
You know there's always a way to approach this from a textbook perspective, and then
there's the experience that every doctor has that helps them solve problems in a way that
is not written about in textbooks or not available from extensive research online.
So I think meeting with more doctors will be of value to you.
I think in general, overall, looking at you, I would not do anything that is very aggressive
and to minimize anything at all.
I may even defer a procedure until a few years later.
So I hope that was helpful and I wish you the best of luck.
Thank you for your question.