In short. Relaxing the depressors lifts the medial brow. When that lift is wanted, when the shape change is not, and how the trade is judged before treating rather than after.
Key points
- The decision is made from the brow position you have now: medial brow height, arch shape, lid edge position, and how much the frontalis is already recruited at rest.
- Those findings say whether the change that follows is one you want.
- Nobody can judge that from a photograph of the crease alone.
Relaxing the corrugator and the procerus does two things at once. It flattens the crease, which is what was asked for, and it changes the pull on the brow, which is the part that has to be judged before treating rather than discovered afterwards.
Why the brow moves at all
The corrugator pulls the inner brow inward and downward, and the procerus pulls the centre of the brow down. Both are depressors. When their pull is reduced, the frontalis, which lifts the forehead, meets less opposition, and the medial part of the brow often rises a little. That lift is frequently wanted: it can open the upper lid area and soften a heavy look.
When the change is not wanted
A medial brow that was already high can go higher, and the upper face can read as different rather than better. In a face whose brow already sits high there is less room for the change before the change becomes the complaint. That is the predictable consequence of removing a downward pull, and the reason the resting brow is measured first.
Judged before treating, not after
The decision is made from the brow position you have now: medial brow height, arch shape, lid edge position, and how much the frontalis is already recruited at rest. Those findings say whether the change that follows is one you want. Nobody can judge that from a photograph of the crease alone.
Effects around the lid
The position of the upper lid depends on a balance of muscles around the eye, and changing any part of that balance can change how open the eye looks. A drooping lid is an uncommon effect that usually settles over weeks. It should be reported to the treating team rather than waited out if it is significant.
Asymmetry, and why the two sides are not treated as one
Because the two sides of a face are not the same to begin with, treating both identically does not produce a symmetrical result. The dominant side is usually the one that needs more reduction, and a plan that ignores the difference produces a brow that no longer matches the person’s own pattern. Where the difference is large, treating in stages is more sensible than making one large change at once.
Findings that need the treating team
- A drooping eyelid, double vision, or difficulty swallowing, speaking or breathing needs emergency care.
- Weakness that spreads beyond the face, or a rash with breathlessness, needs urgent assessment.
- A brow or lid asymmetry that has not settled after a few weeks, or an eye that has become persistently dry or irritated.
Why the brow is involved at all is explained by the anatomy in why frown lines are vertical. What is recorded before treatment is set out in how frown lines are assessed, and the treatment itself is described in botulinum toxin for frown lines.
Frequently asked questions
Is a raised medial brow a complication or a result?
It is a predictable consequence rather than an accident. The muscles being quieted hold the inner brow down, so reducing their pull lets the frontalis lift it. In many faces that lift is wanted and opens the upper lid area. In a face whose brow already sits high, the same lift is the change that becomes the complaint, which is why it is judged before treatment.
Can the brow change be avoided?
It can be planned around rather than avoided altogether, because the muscles responsible for the crease are the same ones holding the brow down. What can be done is to look at the resting brow height, the arch and the lid edge first, treat the pattern that is actually producing the crease, and decide in advance whether the change that follows is wanted. Some faces are better left alone.
What should I do if the brow looks uneven after treatment?
Report it to the treating team rather than waiting it out if it is significant, and expect to be seen rather than reassured by telephone. Most asymmetry after treatment settles as the effect settles, and it is often traceable to a difference between the two sides that was there before. It is worth photographing in the same light so the comparison is against a record.
Risks & Limitations
- Relaxing the corrugator and the procerus also lifts the medial brow, and in a brow that already sits high that lift can become the complaint rather than the result.
- A drooping eyelid, double vision, or difficulty swallowing, speaking or breathing after an injection needs emergency care rather than a wait-and-see approach.
- Resurfacing carries a risk of pigment change and, rarely, of scarring, and its result is judged weeks after the last session rather than on the following morning.
- No rung removes a crease that is established in the skin. A line that is visible at rest usually softens, and any statement that promises more should be treated with suspicion.
When to Seek Care
- Difficulty breathing, chest pain, or difficulty swallowing or speaking after an injection needs emergency care immediately.
- A drooping eyelid, double vision, or an eye that will not close fully after treatment.
- Weakness or numbness on one side of the face, or a brow that has dropped on one side.
- A crease that has appeared or deepened over weeks rather than years, or any change in vision on one side.
References & Further Reading
- American Society of Plastic Surgeons (ASPS) — procedure and safety guidance
- National Institute for Health and Care Excellence (NICE, UK) — relevant guidance
- Cochrane Library — systematic reviews
- Chinese Medical Association Plastic Surgery Branch — clinical guidance
This page is patient education, not medical advice, and it does not cite individual studies. Discuss your own case with a qualified clinician. To arrange an assessment at Chongqing West District Hospital, see Contact & Consultation.