Botox brow lift: what is really known about lifting the eyebrow

The eyebrows are one of the eleven areas of our atlas of botulinum toxin by area of the face. This page is about the brow lift: how it works, what studies show, why it is an off-label use in France, and what its risks are. It does not replace a consultation.

Why is this area treated?

The position of the eyebrow results from a balance between muscles that pull it up and muscles that pull it down. The frontalis lifts it. Other muscles lower it: those of the area between the eyebrows, used for frowning (see the page on frown lines and their muscles), and the outer part of the orbicularis oculi, the ring of muscle around the eye.

A botulinum toxin brow lift relies on this principle: by relaxing some of the muscles that pull the eyebrow down, the frontalis can act a little more, and the eyebrow may rise slightly. In the most often cited study, the toxin was injected into the area between the eyebrows and above the outer part of the eyebrow¹.

This point is often misunderstood: you do not lift the eyebrow by treating the forehead. On the contrary, relaxing the frontalis can make the eyebrow drop, an effect described in the labels². Horizontal lines have their own page, on injections for forehead lines.

What the toxin does not do: it does not replace eyebrow or eyelid surgery, and it does not correct excess skin.

When is the toxin used?

No French label defines an indication for this area, so there are no official criteria. The main published study on the subject, without a control group, shows a modest effect: among seven women aged 31 to 42, five had a lift of 1–3 mm (1 mm on average), two had no change, and all had less marked frowning¹. This is a low level of evidence, in very few people.

The contraindications in the labels apply whatever the area: allergy to the toxin or to a component of the product, a generalised disorder of the muscles and of the junction between nerve and muscle (myasthenia gravis, Lambert-Eaton syndrome), an infection at the injection site^2,3. Treatment is not recommended during pregnancy or breastfeeding^2,3.

Which toxin for the eyebrows?

The type A toxins approved for aesthetic use in France cover frown lines and, depending on the product, crow’s feet and forehead lines^2,4,5. None provides for a brow lift. The short-acting botulinum toxin (serotype E) is approved for frown lines only, in the European Union and in Canada^3,6. For this area, any injection is therefore off-label, whatever the toxin.

Is it right for me?

Your doctor will examine the position and symmetry of your eyebrows, the appearance of your upper eyelids, and how your forehead and the area between your eyebrows move. A low eyebrow caused by excess skin or sagging tissue does not call for the same approach as an eyebrow pulled down by very active muscles.

Your expectations also need to be realistic: the measured effect is around one millimetre, and not everyone gets it¹.

Questions to ask your doctor: is this use off-label, and why are you suggesting it? What result is reasonable in my case? What alternatives exist? What happens if one eyebrow rises more than the other?

Onset and duration

No label gives an onset or duration for this area. In the reference study, the result was measured one month after the injection¹. For frown lines and the forehead, the labels of type A toxins describe an improvement within a few days and an effect shown for about 4 months^2,4.

How these timelines work in general is explained on the page about how long botulinum toxin takes to work.

What are the risks in this area?

The effects most often described around the eyebrow are a drooping eyebrow, the Mephisto sign (tail of the eyebrow arched upwards) and a drooping upper eyelid^2,3. They are temporary. The eyelid is a sensitive area, covered on the page about injections near the eyelids. Small bruises and headaches are also possible².

Difficulty swallowing, speaking or breathing requires immediate medical attention^2,3. A visual disturbance should also be checked by a doctor promptly. If the result worries you, the page on the eyebrows after an injection describes the most common situations, such as an eyebrow that is too high or drooping.