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Avoid a 'Spock Brow' from Botox injections

Posted:10:45 a.m. Friday, July 12, 2013

By Anita Mandal, M.D.
Question: I had Botox to my forehead twice by a plastic surgeon, and my brows looked like “Mr. Spock” from the Star Trek movie. How do I know it won’t happen again if I change surgeons?
Answer: A surprised or “Spock” look after Botox can be avoided with proper injection technique.
The upper face has two muscles types. One group, the elevators, lifts the forehead and enables you to raise your eyebrows. The other group, the depressors, is associated with frowning and pulls the forehead downward.
Brow position results from a combination of the upward force of the elevators and the downward pull of the depressors. When these opposing forces are out of balance, as can occur after an inadequate Botox injection, the brow can appear abnormal.
Botox weakens or relaxes the muscles. Its effect on facial expression depends on which muscle group it is injected into. For instance, Botox injected into the brow elevators can weaken them so the brow is unable to effectively lift. This can result in a droopy or low-set brow.
On the other hand, Botox injected into the brow depressors can relax or weaken these depressors to lessen the downward pull, causing the brows to over-elevate.
The key is to balance the forces between the forehead elevators and depressors. Typically, a “Spock Brow” is due to overtreating depressors and/or undertreating elevators in the outer half of the forehead. It can be corrected by placing a small amount of Botox into the elevators in the outer forehead.
Your surgeon should be able to explain what can be done to avoid the “Spock Brow” and the corrective measures used if it does occur. As a prerequisite, your surgeon should be familiar with the forehead muscles and their actions.

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