Plastic Surgery 101

What you need to watch for with Botox injections — or how not to get droopy brows

An experienced doctor who works with Botox can help prevent some issues that may come up.
An experienced doctor who works with Botox can help prevent some issues that may come up. TNS

Q. I want to do Botox but both times I have done it my forehead has dropped. In particular, the mid-part of my brows seems to have fallen and gives me a weird look. Am I doomed to never be able to use Botox?

A. Whenever I see a patient that tells me what Botox did, I simply say, “It was not the Botox; it was the injector.”

I try to tell people it’s similar to having a surgeon with a scalpel. You can give two surgeons the same scalpel and get entirely different results!

While Botox is not nearly as serious as surgery, picking qualified, well-trained, certified people to handle your injectables is important.

Some patients may not have the strength in their muscles to elevate their forehead after Botox has been injected. This is rare, and a well-qualified injector would modify your treatment the second time.

Patients who have horizontal creases on their nose often have a mid-forehead that is weaker than the average person. In addition, when a patient has a protuberant frontal bone, that may indicate that the injector needs to be more careful.

Botox injections are not just about getting rid of wrinkles, but about rebalancing the muscles of the forehead. Because of the problem you had, it is imperative you choose someone who understands facial muscle anatomy.

Many years ago I had a patient who had forehead droop after having her routine Botox. It became apparent to me that her mid-forehead muscles were not nearly as strong.

A technique that I use, called the box technique, solves much of this issue. I am sure that there are many practitioners who have a similar technique and may call it by different name.

If you are interested in having more Botox injections, you should let your provider know that you have had this problem twice before. By injecting less Botox into the mid-forehead area, your mid-forehead will rise and you will not get this droopy sensation.

Most patients can have satisfying results when being injected by qualified, certified practitioners.

Carlos Wolf is a partner in Miami Plastic Surgery and is board certified. Email questions to him at For more information, videos, and before-and-after photos, follow @carloswolfmd and @mpsmedspa on Instagram.