Brow’s falling after Botox: Why and how to avoid?

People often dislike their forehead furrows (line across the forehead) and ask to have them treated. Many patients complain that the Botox caused my Brows to fall and even cause heavy eyelids. What happened? What went wrong?

Well, in these cases the patients got what they asked for. They asked for a smoother forehead and they got it after Botox. The problem is that the provider did not evaluate the patient and explain why there are forehead furrows. Let’s look at this a little closer.

Many people have forehead furrows because they are contracting their frontalis muscle to elevate their brows and/or eyelids. As a result, they do not like the look of the forehead lines. If the provider does what is asked and treated the forehead, causing paralysis of the frontalis muscle, the patient will get the desired result of a smoother forehead. But, the patient will also get the undesired result of having lower eyebrows and/or eyelids that they will not be able to elevate.

This is one of the most common complaints that I hear from patients whom are treated elsewhere. In the past, brow ptosis (true drooping of the eyelid) did occur when Botox was injected into the wrong site (above the mid to lateral portion of the eyebrow). Today, I rarely see this complication as most providers are very educated to this potential complication.

So what can one do? In short, not everybody is a good candidate for forehead toxin treatment (i.e. Botox, Dysport, Xeomin). Some need a brow lift (either surgical, threads, Ultherapy, or using, believe it or not, toxins injected in just the right place). Some patients can have a little toxin in the forehead to make a balance–slight softening of the forehead with some ability to move the brows (often in combination with using toxins to elevate the brows too). In short, one must always discuss this in detail with their provider prior to treatment to achieve an acceptable result.

Robert S. Bader, M.D., Dermatologist