Spock brow is an informal term for excessive lateral eyebrow elevation following botulinum toxin treatment. It usually occurs when the central portion of the frontalis has been weakened more than the lateral fibres, so the outer forehead continues elevating the brow while the centre is more relaxed.
Possible factors include injection pattern, dose distribution, individual muscle anatomy, strong lateral frontalis activity, pre-existing brow asymmetry and different response between sides.
Often, yes. In selected patients, a very small and carefully placed dose of botulinum toxin to remaining overactive lateral fibres may reduce the exaggerated arch. Correction should follow an assessment of how much movement remains and whether the opposite brow is actually too low.
Not always. Botulinum toxin continues to develop over several days. An eyebrow that looks uneven early after treatment may become more balanced as the effect develops.
The higher brow may not be the real problem. The opposite brow may have become too low because the frontalis was excessively relaxed. Injecting more toxin into the higher side may create a more symmetrical but generally heavier result.
Yes. If too much additional toxin is placed into the remaining active forehead, eyebrow elevation may reduce excessively. Correction should be conservative.
A touch-up is a small additional treatment performed after the initial result has been assessed. It should not mean automatically adding more toxin to every patient.
We assess the face at rest, with brows elevated, during frowning and against pre-treatment photographs when available. The question is whether more Botox improves balance or whether waiting will produce a better outcome.
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