Eye brow drop is one of the most common complications of Botox injections. We have few patients that come new to the clinic that ask us specifically to be careful with the eyebrow as they had them dropped before from previous injectors. But what causes eyebrows to drop? and how can we prevent that?
To understand this, we need to learn a little about anatomy, and what causes our eyebrows to move…
This orange butterfly looking muscle on your forehead is called the Frontalis muscle. This is the muscle responsible for lifting the eyebrows up. Without this muscle the eyebrows would stay in their neutral position while the circular muscle around the eye (Orbicularis Oculi) contracts and pulls the bows down. As we age, we start losing bone volume at the orbital ridge, that’s the bone the eyebrow sits on. That causes the eyebrows to slide down even further. Your face will compensate for this loss by increasing the work load of the Frontalis muscle to pull the eyebrows up and keep them in their normal desired position.
Some people especially men, have naturally heavy eyebrows. They typically have thicker skin and more hair in their eyebrows. These people tend to develop more wrinkles on their forehead at a younger age that are typically deeper and harder to treat.
When my husband and I were in residency and way before I became an injector, I noticed that my husband has strong and deep wrinkles on his forehead that were noticeable from far away. We are both the same age yet these wrinkles made him look somehow older. Being the good wife I am, I decided to gift him a trip to a medical spa to get these wrinkles treated. But if I knew then what I know now, I would’ve never done that!!
Despite his objections, I asked the injecting nurse to make him look younger and she loaded his forehead with Botox. Four days later, Botox started kicking in and his forehead was super smooth. But this came with a price! His eyebrows drooped so low it was difficult for him to see without lifting his head up or pulling his eyebrows manually. He had headaches continuously because his vision was compromised. And needless to say, although his forehead looked nice and shiny, his whole face looked tired and unsatisfactory. Thankfully, these symptoms lasted for few weeks, and he got to enjoy a smoother forehead for a couple of months.
The short answer is YES! An experienced injector with a good understanding of facial anatomy will be able to assess the role the Frontalis muscle is playing in the lift of the eyebrow. He/she will make adjustments in the location, depth and dose of his/her injections. If the eyebrow’s location is dependent on the continuous pull of the Frontalis muscle. Your doctor may choose to reduce the dose of your toxins, make the injections too high, or even skip treatment of the forehead all together!
Another important point to know is that even with the treatment of the Glabellar muscles (frown muscles), there is a risk of eyebrow drop if the injector injects too superficial or too deep. A good injector understands that muscles don’t necessarily lay in the same plane all through. In addition, intersections among muscles is very common. That’s why choosing your injector is the most important part of your treatment. Even more important than the type of neurotoxin you choose.
Unfortunately there’s no antidote to (counteract Botox). Eyebrow drop is so annoying to patients but thankfully the effects of Botox are not permanent. The eyebrows can start rising even before the full effect of Botox on the forehead wears off. It might take 4-6 weeks, but the eyebrow will be back to it’s normal position for sure.
Sometimes, we can help the eyebrow to lift by giving Botox to the muscle that pulls it down, Orbicularis Oculii. This is the same muscle that wraps around the eye to close it. Injecting it laterally in very specific points can help lift the eyebrow without affecting the movement of the eyelids.
