Spock Eyebrows After Botox: Why does it happen, and what can you do about it?

Formulate user Deirdre wrote in with some questions about potential Botox complications:

I've heard that sometimes when people get botox their eyebrows go up in the corner, like Spock, or start to feel really heavy and difficult to lift up. Why do these things happen, and are they medically concerning? Can it be fixed very easily? Obviously I don't want these things to happen to me, so what can I do to prevent complications And if I don't like the results of Botox, how long will it take to wear off?

Thanks for writing, Deirdre! To answer your questions, we spoke with Dr. Kunal Malik, a board-certified general and cosmetic dermatologist at Spring Street Dermatology and Assistant Clinical Professor of Dermatology at the Mount Sinai Hospital in NYC. Dr. Malik is widely published and has authored over 30 publications in high profile journals, has given talks at national meetings, and sits on key Advisory and Editorial Boards in the field. We're sure his input will be helpful in answering your questions!

What causes the side effect of heavy eyebrows post botox? How can it be fixed?

Dr. Malik: Brows or eyelids that feel heavy after a Botox injection, having trouble fully opening the eyes, droopy eyelids/brows -- these are all signs of ptosis*.

Ptosis resolves with time. I always ask the patient to wait two weeks post injection as injections can kick in unevenly. Another option is to perform a compensatory brow lift, also done with botox, to target the brow depressors. These procedures should be performed only by an experienced dermatologist or plastic surgeon.

*Editor's note: Ptosis is a drooping of the upper eyelid. It may limit or block normal vision.

Are heavy eyebrows a common side effect? Is it a concerning side effect?

Dr. Malik: This is not a common or concerning side effect. It happens 1-5% of the time. It only becomes concerning if there is restriction in vision, in which case the brow or lid may need to be corrected to restore normal vision.

What causes "spock eyebrows" post botox? How can they be fixed?

Dr. Malik: This happens when the central frontalis** is injected, and the lateral frontalis is untouched. When the central forehead is weakened and the outer sides remain active, it causes the central brow to drop and the outer brow to appear spocked. It is fixed by injecting a few units of Botox laterally into the frontalis muscle above each brow.

**Editor's note: The frontalis is the muscle responsible for elevating the eyebrows.

Are "spock eyebrows" a common side effect? Besides aesthetically, are they a concerning side effect?

Dr. Malik: This is a very common side effect and can easily be corrected. It is not concerning medically.

Is there anything you can do if you get botox around your eyebrows/eyes/forehead and you don't like the results? Can you make the botox wear off more quickly?

Dr. Malik: A few things can be done:

You can wait. Botox takes some time to fully settle in, so it is possible that the full effect of the treatment has not yet been achieved. Patients may like the results more after a few days or weeks. Botox results are temporary and will fade over time. The effects typically last between three and six months, so you may find that the unliked results will improve as the treatment wears off.

Sometimes, a small touch-up can make a big difference in the final result. The treating doctor may suggest a follow-up treatment to help refine the initial results.

Certain eye drops can help if botox causes a droopy lid. It is important to get an evaluation with an experienced dermatologist prior to taking any action to self-correct unsatisfactory botox results.

Besides spock eyebrows and heavy eyebrows, what are the potential risks and side effects of getting Botox injections around the eyebrows/eyes/forehead?

Dr. Malik: Botox injections are generally safe, but like any medical procedure, there are potential risks. Some of these include:

Drooping eyelids: Botox injections can sometimes cause eyelid drooping, which can affect vision. This usually occurs when the injections are placed too close to the brow line or in the wrong muscles.
Bruising and swelling: Like with any injection, bruising and swelling can occur at the injection site. This is usually temporary and should resolve within a few days.
Headaches: Some people may experience headaches, but this is temporary.
Allergic reaction: While rare, some people may have an allergic reaction to Botox. Symptoms may include difficulty breathing, swelling of the face or throat, and hives.
Numbness or tingling: Botox injections can sometimes cause numbness or tingling around the injection site, but this is usually temporary.

How long will the effects of the Botox injections last on the eyebrows/eyes/forehead?

Dr. Malik: Typically the effects last between 3-6 months. The duration of the effect can vary depending on a number of factors, including the amount of Botox injected, the individual's metabolism, and the specific muscles targeted.

Over time, the effects will gradually wear off as the body metabolizes the toxin. As the effects begin to fade, wrinkles and lines in the treated area will return but may be softer.

That being said, there is a new toxin now approved (Revance's Daxxify) which can sustain results for six months and up to nine months in some patients.

Are there any factors that could increase the risk of experiencing side effects or complications from Botox injections on the eyebrows/eyes/forehead?

Dr. Malik: Yes,

Botox injections have not been extensively studied in pregnant or breastfeeding women, so it is recommended that women avoid the procedure during these times.
People with certain medical conditions, such as ALS, myasthenia gravis, or Lambert-Eaton syndrome, may be at increased risk of experiencing complications from Botox injections.
Medications: Some medications, such as blood thinners, muscle relaxants, and certain antibiotics, may increase the bleeding, bruising, or other complications from injections.
People who have a history of allergic reactions to botox or any of its constituents should not undergo the procedure.
If there is an infection at the injection site or surrounding area, it may not be safe to treat
People who have had prior facial surgeries or cosmetic procedures may be at increased risk of complications from Botox injections due to altered facial anatomy.