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In cosmetic applications, botulinum toxin is considered safe and effective for reduction of facial wrinkles, especially in the uppermost third of the face. Injection of botulinum toxin into the muscles under facial wrinkles causes relaxation of those muscles, resulting in the smoothing of the overlying skin. Smoothing of wrinkles is usually visible three days after treatment and is maximally visible two weeks following injection. The treated muscles gradually regain function and generally return to their former appearance three to four months after treatment. Muscles can be treated repeatedly to maintain the smoothed appearance.

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YOU ASKED: How Full Results of Botox® can Take 2 Weeks After Treatment to Appear

When eyebrows are raised, very Spock-like with one higher than the other. Will this get better or worse in the next few days? I don’t want to return to original Doctor, as I’m worried that I might get worse. I can’t go back anywhere for 2weeks, as I am going on holiday. It looks fine until my eyebrows are raised. I had Botox in frown lines and forehead. He said it was a small dose, as I didn’t want to freeze and look. Frown lines are still there. 

You submitted your question with 1-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 on 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.

Botox®, 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. And the doctor’s goal was to you 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, it’s called the eyebrow elevator and then muscles called the frontalis muscle. And then 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 eyebrow 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 2weeks. And the reason is the Botox® has its usual effect around 3days after injection and then has its peak effect at 2weeks, which means that you still haven’t realized the full effect of the treatment. Now can it get better or worse? Well, it takes 2weeks to see and I understand that in your question, you wrote that you could 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 of getting about the 2weeks 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 were 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 that you do feel comfortable with and try to maintain that relationship so that doctor and you get to work together on a way that will 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 become 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.