Vertical Lines Above Eyebrows After Botox – Informative Aspects

Medically Reviewed
Medically Reviewed by Dr. Aurora Kalmanson on
Written by Fillers Editorial Team, plastic surgery specialists.

Vertical lines appearing above the eyebrows after botox treatment can be concerning for patients seeking a smoother forehead. These lines typically result from the complex interplay of facial muscles and the effects of botox injections.

While botox effectively relaxes targeted muscles to reduce wrinkles, it can sometimes lead to unexpected results, including vertical forehead lines. This occurrence is often due to the partial treatment of forehead muscles, uneven distribution of the toxin, or individual facial anatomy. Understanding the causes and available solutions can help patients achieve their desired results and maintain a natural, youthful appearance.

Reasons for Vertical Lines Above Eyebrows After Botox

While botox is highly effective for treating wrinkles, vertical lines above the eyebrows can occasionally occur. These lines may result from various factors, including injection technique, muscle dynamics, and individual facial anatomy.

Incorrect Placement of Botox Injections

Injections Too Low on Forehead: When botox is injected too low on the forehead, it can lead to the appearance of vertical lines above the eyebrows. This occurs because the lower part of the frontalis muscle becomes overly relaxed, while the upper portion remains active. As a result, when patients try to raise their eyebrows, only the upper part of the muscle contracts, creating an uneven tension that manifests as vertical lines or ridges. This issue is particularly noticeable in individuals with a naturally low brow position or those with a strong frontalis muscle. To avoid this problem, experienced practitioners carefully assess the patient’s facial anatomy and muscle movement patterns before treatment, ensuring that injections are placed at the optimal height on the forehead to achieve a balanced and natural-looking result.

Uneven Distribution of Botox: Uneven distribution of botox can lead to asymmetrical results, including the appearance of vertical lines above the eyebrows. This occurs when the neurotoxin is not evenly spread across the targeted muscle groups, resulting in some areas being more relaxed than others. Factors contributing to uneven distribution include improper injection technique, inconsistent depth of injections, or the movement of the product after injection. When certain parts of the frontalis muscle remain more active than others, it can create an imbalance in muscle tension, leading to the formation of vertical lines or ridges when attempting to raise the eyebrows. Skilled practitioners use precise injection techniques and carefully plan injection points to ensure even distribution across the treatment area, minimizing the risk of uneven results.

Insufficient Dosage of Botox

Not Enough Units Used: When an insufficient number of botox units is administered, it can result in incomplete muscle relaxation and suboptimal wrinkle reduction. The correct dosage varies depending on factors such as muscle strength, treatment area size, and individual patient characteristics. If too few units are used, some muscle fibers may remain active, leading to partial movement and the potential formation of vertical lines above the eyebrows. This occurs because the partially treated muscles still attempt to contract, creating tension in the forehead area. Experienced practitioners carefully assess each patient’s needs and adjust the dosage accordingly, often starting conservatively and adding more units if necessary during follow-up appointments to achieve the desired effect without overcorrection.

Inadequate Relaxation of Muscles: Inadequate relaxation of muscles following botox treatment can occur when the dosage is insufficient or when the product is not effectively distributed throughout the target muscle. This partial relaxation can lead to uneven tension across the forehead, potentially causing vertical lines to appear above the eyebrows. When muscles are not fully relaxed, they may still attempt to contract, creating visible ridges or bands in the skin. Additionally, inadequate relaxation can result in a shorter duration of effect, with wrinkles reappearing sooner than expected. To address this issue, practitioners may need to adjust their injection technique, increase the dosage, or consider alternative treatment plans to ensure comprehensive muscle relaxation and optimal aesthetic outcomes.

Individual Facial Anatomy and Muscle Strength

Variations in Muscle Size and Position: The size and position of facial muscles can vary significantly among individuals, influencing the effectiveness of botox treatments and potentially contributing to the formation of vertical lines above the eyebrows. Some people may have larger or stronger frontalis muscles, requiring higher doses of botox for adequate relaxation. Others may have asymmetrical muscle development or unusual muscle fiber orientations, which can affect how the forehead responds to treatment. These anatomical variations can lead to uneven relaxation or unexpected movement patterns post-treatment, potentially causing vertical lines or ridges. Skilled practitioners conduct thorough assessments of each patient’s facial anatomy before treatment, adapting their approach to accommodate these individual differences and achieve more predictable, harmonious results.

Resistance to Botox Effects in Some Individuals: A small percentage of individuals may exhibit resistance to the effects of botox, leading to suboptimal results and potential vertical lines above the eyebrows. This resistance can be due to various factors, including the development of neutralizing antibodies against the botulinum toxin, particularly in patients who have undergone frequent treatments over an extended period. In some cases, certain individuals may have a naturally higher metabolic rate that breaks down the toxin more quickly, reducing its effectiveness. Additionally, some people may have exceptionally strong facial muscles that require higher doses for adequate relaxation. When botox resistance occurs, practitioners may need to explore alternative neurotoxin formulations, adjust treatment protocols, or consider complementary treatments to achieve the desired aesthetic outcomes.

Temporary Side Effect During Adjustment Period

Muscles Adapting to Botox: During the initial period following botox injections, muscles undergo an adaptation process that can sometimes result in temporary vertical lines above the eyebrows. As the neurotoxin begins to take effect, certain muscle fibers may relax more quickly than others, leading to uneven tension across the forehead. This adaptation phase typically lasts for a few days to a week, during which patients might notice slight changes in muscle movement and skin appearance. The frontalis muscle, responsible for raising the eyebrows, may respond unevenly, causing temporary creases or lines when attempting to make certain expressions. It’s important for patients to understand that this adjustment period is normal and usually resolves as the full effects of botox set in, resulting in a smoother, more uniform appearance of the forehead.

Possible Slight Overcompensation by Untreated Muscles: In some cases, vertical lines above the eyebrows may appear temporarily due to the overcompensation of untreated muscles adjacent to the botox-injected areas. As certain muscles become relaxed by the neurotoxin, neighboring untreated muscles may instinctively work harder to maintain facial expressions, potentially leading to the formation of new lines or wrinkles. This phenomenon is particularly noticeable in the forehead region, where the interplay between the frontalis and surrounding muscles is complex. Patients might observe increased activity in the upper portion of the forehead or around the temples as these muscles attempt to compensate for the reduced movement in treated areas. This overcompensation is typically short-lived, subsiding as the body adjusts to the new muscle dynamics created by the botox treatment.

Correcting Vertical Lines Above Eyebrows After Botox

Despite best efforts, vertical lines may sometimes appear above the eyebrows after botox treatment. Fortunately, there are several approaches to address this issue, including waiting for full results to develop and considering touch-up treatments if necessary.

Waiting for Full Results (Up to 2 Weeks)

Allowing Time for Muscles to Fully Relax: After botox injections, it’s crucial to allow sufficient time for the muscles to fully relax and for the treatment to take full effect. This process typically takes up to two weeks, during which the neurotoxin gradually binds to nerve endings and inhibits muscle contractions. During this period, patients may notice progressive changes in their facial appearance, including the gradual softening of wrinkles and a reduction in muscle movement. It’s important for patients to remain patient and avoid making premature judgments about the treatment’s effectiveness. The initial appearance of vertical lines above the eyebrows may be temporary and could resolve as the muscles continue to relax. Practitioners often advise patients to refrain from excessive facial expressions or massaging the treated area during this time to ensure optimal results.

Assessing Results After Adequate Settling Period: Properly assessing the results of botox treatment, including the presence of any vertical lines above the eyebrows, should only be done after an adequate settling period. This typically involves waiting for the full two-week period to allow the botox to take complete effect. During this time, the treated muscles will continue to relax, and any initial asymmetries or unexpected lines may resolve on their own. At the two-week mark, practitioners usually schedule a follow-up appointment to evaluate the treatment outcomes. This assessment involves a thorough examination of the patient’s facial expressions, muscle movement, and overall aesthetic appearance. Any persistent vertical lines or other concerns can be addressed at this point, allowing for a more accurate determination of whether additional treatments or adjustments are necessary.

Touch-Up Treatments

Additional Botox in Specific Areas: In cases where vertical lines above the eyebrows persist after the initial settling period, administering additional botox in specific areas can be an effective solution. This touch-up treatment targets any remaining muscle activity that may be contributing to the formation of these lines. The practitioner carefully assesses the patient’s facial movements and pinpoints the exact locations where additional botox is needed. These touch-up injections are typically smaller in dosage and more precisely placed than the initial treatment. By strategically adding more botox to specific muscle fibers, the practitioner can achieve a more balanced relaxation across the forehead, potentially removing or significantly reducing the appearance of vertical lines. This approach allows for fine-tuning of the results without risking over-treatment or an unnatural appearance.

Adjusting Dosage or Placement: When addressing persistent vertical lines above the eyebrows after botox treatment, adjusting the dosage or placement of injections can be a crucial step. This process involves a careful re-evaluation of the patient’s muscle dynamics and response to the initial treatment. Practitioners may decide to increase the dosage in certain areas where muscle activity remains stronger than desired, or they might adjust the placement of injections to target specific muscle fibers more effectively. In some cases, a slight reduction in dosage in certain areas might be necessary to allow for more natural movement and prevent overcompensation by untreated muscles. The goal is to achieve a harmonious balance across the forehead and brow area, ensuring even muscle relaxation and a smooth appearance. This adapted approach to adjusting treatment demonstrates the importance of personalized care in achieving optimal botox results.

Complementary Treatments

Dermal Fillers for Deep Lines: In cases where vertical lines above the eyebrows persist after botox treatment, dermal fillers can be an effective complementary solution. These injectable treatments work by adding volume beneath the skin, effectively “filling in” deep lines and wrinkles. Hyaluronic acid-based fillers are commonly used for this purpose due to their natural-looking results and reversibility. When used in conjunction with botox, fillers can address static wrinkles that remain visible even when facial muscles are relaxed. The combination of muscle relaxation from botox and the volumizing effect of fillers can provide a more complex rejuvenation of the forehead area. This dual approach not only smooths out existing lines but also helps prevent the formation of new wrinkles by supporting the skin structure.

Laser Resurfacing for Skin Texture Improvement: Laser resurfacing treatments can be an excellent complement to botox for improving overall skin texture and minimizing the appearance of vertical lines above the eyebrows. This treatment uses focused light energy to remove the outer layers of damaged skin and stimulate collagen production in deeper layers. For persistent lines, fractional laser treatments can be particularly effective, creating microscopic wounds in the skin that trigger the body’s natural healing response. This process leads to the formation of new, healthier skin cells and increased collagen production, resulting in smoother, more even-textured skin. When combined with botox, laser resurfacing can address both the muscular causes of wrinkles and the skin’s surface appearance, providing a more complex solution for forehead rejuvenation.

Frequently Asked Questions

How long do vertical lines above eyebrows last after botox?

Vertical lines above the eyebrows typically diminish as botox takes full effect, which can take up to two weeks. If these lines persist beyond this period, it's advisable to consult with your treatment provider for further evaluation and possible touch-ups.

Can botox be used to lift droopy eyebrows as well as treat wrinkles?

Yes, botox can be strategically injected to lift droopy eyebrows while also treating wrinkles around the forehead and eyebrow area. This dual action requires precise injection techniques and is best performed by an experienced practitioner to ensure balanced and natural-looking results.


The appearance of vertical lines above the eyebrows after botox can be effectively managed and prevented through precise injection techniques, appropriate dosage, and comprehensive follow-up care. Understanding the interaction of facial muscles and botox's effects is essential for achieving optimal results. Regular maintenance treatments, combined with a healthy skincare regimen and sun protection, further enhance the long-term benefits of botox. By choosing an experienced injector and following professional advice, patients can enjoy a smoother, more youthful appearance with minimized risks of unwanted side effects.

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Kang, S. M., Feneran, A., Kim, J. K., Park, O., Kim, J. E., Won, C. H., Chang, S., Lee, M. W., Choi, J. H., Moon, K. C., Youn, C. S., Cho, S., & Lee, S. H. (2011). Exaggeration of wrinkles after botulinum toxin injection for forehead horizontal lines.

Dr. Aurora Kalmanson

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The information provided in this blog is for informational and educational purposes only and should not be interpreted as personalized medical advice. It's crucial to understand that while we are medical professionals, the insights and advice we provide are based on general research and studies. They are not tailored to individual health needs or conditions. Thus, it is essential to consult directly with a healthcare provider who can offer personalized medical advice relevant to your specific situation.