The injectable aesthetic drugs, Botox and Dysport, are the single most effective non-surgical treatments for unwanted forehead wrinkles. They are simple to inject and generally work very well. But adverse effects from their use do occur and it is usually that of unpredicted or undesired aesthetic effects.
The most dreaded and well known complication of injectable neuromuscular facial treatments is upper eyelid drooping, known as ptosis. This occurs when the toxin diffuses or migrates from an injection site in or around the eyebrows down into the upper eyelid. The position of the upper eyelid margin drops down, covering some portion of the iris. This is easily seen by all and no patient wants to walk around for months with an eyelid at ‘half-mast learn more about contour rx here‘. This results from injecting too close to the eyebrow or putting in large volume in an injection site near the eyebrow. Fortunately, eyelid ptosis is very uncommon as there is no known reversal or antidote to this problem other than letting it wear off.
One of the more frequently seen adverse effects is an unusual or unnatural looking forehead movements. When the area between the eyebrows (glabella) is treated, those pesky vertical lines and furrows will go away but the rest of the forehead is unaffected. For those with very active forehead movements, this can result in a central zone of paralysis amidst a sea of moving forehead areas. This may also make the eyebrows lift up in its mid- to lateral parts but not in the brow area closest to the nose. (known as a ‘Spock’ brow) These abnormal forehead movements can be easily managed by the judicious placement of injections in other areas of the forehead to soften those movements and create a less active but more symmetric movement of the forehead and brows.
The last adverse forehead effect is an undesired lowering of the eyebrows, also known as ptosis. When too many injections are done above the brow and across the forehead, the eyebrow may feel heavy and actually drop a little bit. The arch of the eyebrow may change as well. In some cases, placing injections high up along the scalp line may cause the eyebrow to raise although this is not always successful.
Botox and Dysport have a very profound reducing effect on facial muscle movements where they are injected. But forehead movements, eyebrow and eyelid positions all may be adversely effected by these injections and sometimes it is possible to have too much of a good thing. In some cases, additional ‘balancing’ injections can be done to counteract how the muscle movements have been affected. When in doubt as to whether more injections can be effective, I prefer in my Indianapolis plastic surgery practice to first use a local anesthetic that lasts for 24 hours or so and see if the patient finds it helpful…before proceeding with the longer acting injections. Upper eyelid ptosis, however, is largely irreversible and must await the tincture of time.
Your thyroid gland controls many body processes, such as the rate of metabolism. This butterfly-shaped endocrine gland manufactures and secretes thyroxin (T4) in response to the release of TSH from the pituitary gland. The thyroid responds by producing and secreting the needed amount of thyroid hormone into the blood stream.
If there is not enough T4 in the system, it is classified as hypothyroidism. On the other hand, if there is too much thyroid hormone it is called hyperthyroidism. Both conditions are autoimmune diseases denoting thyroid hormone imbalance that can show outward signs of it’s existence, such as thyroid eye disease.
What Is Thyroid Eye Disease?
Thyroid eye disease, or TED, is characterized by the protrusion of the eyeballs. It is most prevalent in Graves disease, caused by an overproduction of thyroid hormone or hyperthyroidism, also known as overactive thyroid. This condition also presents itself when thyroid hormone levels are normal (euthyroid), as well as when there is inefficient thyroid hormone (hypothyroidism) present in the body.
Another name for this disease is exophthalmia, as well as orbitapathy and ophthalmopathy. The condition can progress to the point that it prevents the eyelids from closing completely, leading to dryness and irritation of the eyeball. Many times, it may be necessary to tape the eyelids shut during sleep to avoid further eye damage.
The effects of thyroid disease have an impact on the eye muscles that become swollen, pushing the eyeball forward. Other causes may include infection of the eye, enlarged blood vessels, and tumors. The bulging may occur in one or both eyes. Approximately 80 percent of all patients with TED have Graves’ disease, due to hyperactive thyroid. Other cases involve Hashimoto’s thyroiditis Hashitoxicosis, or atrophic thyroiditis.