I had a patient come in the other day who had just had botox by a different doctor. She said “the botox is not working for me like it used to,” and asked me if I could help. I had her raise her forehead, furrow her brow, smile. She was pretty blocked in the areas, and I told her it seems to be working. And then she said how she liked her forehead to be smooth. Super smooth.
Ahh. I get it.
So then I had to have the talk, which I hate to give, about how aging continues. What works for you when you are 30 may not work for you when you are 40. She can’t get that super smooth forehead anymore without dropping her eyebrow, which will make her look tired.
Why does the botox “stop working”? Because we continue to age. Particularly for the forehead, as you age, your brow drops. The reason you form the forehead lines is because you are lifting your eyebrows up with your forehead muscle so you can see. It’s a bit of a paradox- as your forehead lines get deeper you want to do botox more, but that is just when you can’t– If you block that forehead muscle, you will get a smooth pretty forehead. No wrinkles. But your brow will drop. And for many, it will cause hooding over the eye and have the opposite effect of what you want- it will make you look older and more tired, not rested.
So what is the fix?
In many ways botox is a bandaid. At some point you need to fix the problem. The problem is some combination of your eyebrow falling down too low and your upper eyelid having too much extra skin. The fix is an eyelift, browlift, or a combination. To figure out which is best for you, consult a plastic surgeon to help you evaluate. The surgeries have different downtimes, scars, etc. and you need to figure out which one will best address what bothers you.
So the botox is working. The issue is aging marches on.
