Injectable cosmetic drugs, Botox and Dysport, are the most effective non-surgical treatments for unwanted forehead wrinkles. They are easy to inject and generally work very well. But adverse effects from its use do occur and are generally unintended or unwanted cosmetic effects.
The most feared and well-known complication of injectable neuromuscular facials is drooping of the upper eyelid, known as ptosis. This occurs when the toxin diffuses or migrates from an injection site in or around the eyebrows to the upper eyelid. The position of the upper eyelid margin falls downward, covering a part of the iris. This is easy for everyone to see and no patient wants to walk around for months with an eyelid at ‘half mast’. This is the result of injecting too close to the brow or putting a large volume at an injection site near the brow. Fortunately, ptosis is very rare, as there is no known antidote or reversal for this problem other than letting it go away.
One of the most common side effects is unusual or unnatural movement of the forehead. When the area between the eyebrows (glabella) is treated, those annoying vertical lines and furrows will disappear, but the rest of the forehead will not be affected. For those with very active frontal movements, this can result in a central zone of paralysis amidst a sea of moving frontal areas. This can also cause the brows to rise in the middle and sides, but not in the area of the brows closest to the nose. (known as ‘Spock’ brow) These abnormal movements of the forehead can be easily controlled by the judicious placement of injections in other areas of the forehead to smooth out these movements and create a less active but more symmetrical movement of the forehead and brows.
The last adverse effect on the forehead is an unwanted lowering of the eyebrows, also known as ptosis. When too many injections are given above the brow and on the forehead, the brow can feel heavy and actually droop a bit. The arch of the eyebrow can also change. In some cases, injections high on the scalp line can cause the eyebrow to rise, although this is not always successful.
Botox and Dysport have a very profound reducing effect on the movements of the facial muscles where they are injected. But the movements of the forehead, brows, and eyelid positions can be negatively affected by these injections, and sometimes it’s possible to have too much of a good thing. In some cases, additional “balancing” injections may be given to counter how muscle movements have been affected. When in doubt as to whether further injections might be effective, I prefer in my Indianapolis plastic surgery practice to first use a local anesthetic that lasts for about 24 hours and see if the patient finds it helpful…before moving on to the long acting. injections Ptosis of the upper eyelid, however, is largely irreversible and must await tincture of time.