Spock eyebrows after Botox: how to fix?

The Spock brow is a fairly common bad cosmetic outcome resulting from botulinum toxin injections such as Botox. It is sometimes referred to as “Joker eyebrow” and to an experienced eye this is a clear give away that you had anti-wrinkle injections.

So why does the Spock brow happen? And what is it exactly? Is it possible to fix? I’ll answer all these questions in the next paragraphs.

spock eyebrow after botox
Commander Spock and his well known eyebrows from TV Series Star Trek – Source: startrek.com

What are Spock eyebrows after Botox?

Spock eyebrows are brows that arch up laterally, towards the sides of your forehead. This unnatural look is the result of injecting Botox without balancing the dose properly between the muscles involved in facial expressions in your upper face.

The anatomy of the forehead muscles

The following are the main muscles on the forehead that are injected with Botox to prevent/treat expression lines and wrinkles:

Procerus muscle, it attaches to the top part of the nose and goes upwards to the left and right of the midline of the forehead, attaching to the frontalis muscle. When contracted it creates a horizontal line in the glabella by pulling the skin between the eyebrows downwards.

procerus muscle for botox treatment
Procerus muscle

Corrugator muscle, right above the eyebrows, when contracted it pulls them downwards and medially (close together), producing the two vertical lines in the glabella.

corrugator muscle for botox treatment
Corrugator supercilii muscle

Frontalis muscle, covering a large part of the forehead from the eyebrows to the scalp, when contracted it pulls the eyebrows upwards and produces the horizontal frown lines.

frontalis muscle for botox treatment
Frontalis muscle (aka Occipito-frontalis)

Orbicularis oculi, around the eyes and oval shaped, although not really a forehead muscle it is an antagonist to the frontalis, it pulls the eyebrows downwards allowing us to close the eyes. It is usually injected laterally as it is responsible for the crow’s feet.

orbicularis oculi muscle for botox treatment
Orbicularis oculi muscle

Depressor supercilii, a triangular shaped muscle originating from the frontal process of the maxilla (roughly between the nose and the eye) which mixes with fibers of the orbicularis oculi and corrugator muscles contributing to some eyebrow movements.

depressor supercilii muscle for botox treatment
Depressor supercilii muscle

Although you can find human anatomy images that all look the same even in medical textbooks, the reality is that we are all different and there is great variation between individuals: the frontalis muscle for example has 4 main classifications corresponding to 4 distinct anatomical shapes which also produce a different wrinkle patterns when the muscle is activated. This is why a plastic surgeon can’t apply the same dose of botulinum toxin in the same injection sites for each of their patients, but has to use a personalized approach, determined during the consultation, with each of them.

Here below you can visualise each of the muscles mentioned above.

anatomy of the facial muscles for botox treatment
Facial muscles anatomy for botox treatment

Why do Spock eyebrows happen?

Doctors have been taught to completely avoid the area that goes from the mid-brow to the side of the face, 1-2 cm above the brow. This is to avoid another possible side effect of Botox injections, which is the brow ptosis commonly referred to as droopy eyelid or eyebrow.

Due to the inability to contract the treated muscles, sometimes our body tries to compensate and recruit other muscle fibers to try and perform the same movements, such as lifting your brows; if the lateral part of the frontalis has not been treated, that is the part that can try and compensate for the chemo-denervation of the procerus and corrugator muscles, causing the lateral arch or Spock brow look.

Also keep in mind that this is not necessarily a mistake made by your specialist: while in some cases it is clearly foreseeable during consultation, in others it is better to take a safe approach and inject a lower dose and/or avoid some areas during the first treatment session and then having a touch-up session 10-14 days later to fix imbalances. With Botox you can always add more, but you can never reverse its effects, only time can.

Can you fix Spock eyebrows?

Yes, Spock eyebrows are an easy fix. You just need to wait for botulinum toxin to be in full effect, meaning you need to wait 10-14 days and then go back to your doctor’s office. A few units, probably no more than 4, will be injected in the frontalis muscle laterally, above the arched brow, to stop it from compensating and being overactive.

How to prevent it from happening again?

Most of the times, an experienced injector will already know how to prevent this from happening: this is done by testing your facial expression muscles prior to the treatment with Botox. In some cases, the occurrence of Spock eyebrows may not be easily foreseeable which is why physicians ask you to come back to their office 10-14 days after your treatment, to make sure you have been treated symmetrically and to correct any imbalance that may have arisen. Next time you’ll be treated he will remember about it and will inject your lateral frontalis muscle preventatively.

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    R. Ruiz-Rodriguez – Actas Dermo-Sifiliográficas, Jul 2015
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