Thank you for your question.
You submitted your question with one photo.
And you state that when your eyebrows are raised, after undergoing Botox® 5 days prior
that you have a Spock-like appearance.
And in the narrative of your question, you state that you are concerned about going back
to the original doctor who did this because you’re afraid it will make the situation
worse.
And further you describe that you had the Botox® done in your forehead and frown lines.
And the doctor had done a conservative dose so that you wouldn’t be frozen and your
last sentence is that the frown lines are still there.
Well, I can certainly share with you my limited assessment from this photo and your history
and how I would typically counsel patients in my practice when it comes to understanding
what’s going on with Botox®.
And of course, you want to know is this going to get better or worse in the next few days.
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.
Botox®, Dysport, Xeomin, basically neurotoxin use in my practice has been significant and
continues to grow for the duration of my years in practice.
In fact, my specialty, oculoplastic surgery, we’re amongst the first doctors to use botulinum
toxin and so I’ve been using Botox® for patients since 1993.
And what I can tell you is that of course, it is very important when I counsel my patients
about the use of Botox® that I try to help and also convey the understanding of the principles
behind what is being done.
So to begin with, you had the treatment done for forehead and frown lines.
The doctor’s goal was to still have some activity.
Well, there are specific muscles that are important when it comes to this area.
And very often, it is perfectly rational and reasonable to be conservative to at least
allow for some movement.
A lot of times patients fall into one of two camps: one camp wants absolutely no movement
at all and the other camp wants to have some movement with expression.
So one of the things I can tell you again is that the anatomy is the key to understanding
this.
So there’s a muscle that lifts the eyebrow called the eyebrow elevator and that muscle
is called the frontalis muscle.
And the muscle that is responsible for the forehead lines is the corrugator and procerus
muscle and those are referred to as eyebrow depressors.
Well, there’s a balance that’s always attempted such that you reduce the activity
of the frown lines which causes the frown lines to go downward and inward.
And at the same time, you want to minimize the exaggerated effect that can result if
you don’t adequately and properly in the right places relax the forehead muscles which
then, in certain areas, can potentially overact and in those areas typically, you get this
arching otherwise known as the Spock appearance.
Now, I understand your hesitation about going back to the original doctor but I can tell
you that in my practice, the way I deal with new patients who are doing Botox® is I actually
intend to see them again in two weeks.
And the reason is that Botox® has its usual effect around 3 days after injection and then
has its peak effect at two weeks which means you still haven’t realized the full effect
of the treatment.
Now can it get better or worse?
Well, it takes two weeks to see and I understand that in your question, you wrote that you
would be away on a holiday.
Now certainly, you can reach out to the doctor and I think that it’s a very straightforward
issue to resolve.
Basically the lines that you see that are above the peak of the Spock eyebrows is sometimes
referred to as comma lines.
And it is very straightforward that you can get micro doses of Botox® to allow for relaxation
of some of the more superficial fibers of the frontalis muscle while at the same time,
maintaining some movement of the muscle.
I think that my point again about the two weeks follow-up is there is a process of getting
to know every patient.
You know, a lot of people think of injectables like commodities where it’s equal everywhere
you go like buying appliances.
But the reality is there is so much nuance in doing this in a way that is right for the
individual patient and there is a “get to know you” process that I value in helping
my patients achieve an optimal look.
And within the ever growing field of ways to do Botox®, even in an area as straightforward
as the forehead, there are many nuanced approaches to deliver the Botox® in a way that can give
you the, what I feel is the best result that is right for the patient.
And as I was referring to earlier, there is also the nuanced micro dose and doing things
in a way so that it looks natural and still get an ideal outcome.
So I would say give your doctor a chance to maybe potentially help you.
Otherwise, if you’re still not comfortable, find another doctor who is very experienced
with Botox® so that you can at least deal with those comma lines but I would recommend
that you find someone who you feel comfortable with and try to maintain that relationship
so that doctor and you get to work together in a way that can be consistent.
Botox® requires maintenance and so coming in every 4-6 months depending on what kind
of look you want to maintain is going to be a regular thing for you.
And so, you should find someone that you’re comfortable with.
So I hope that was helpful, I wish you the best of luck and thank you for your question.