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Droopy Eyelid After Botox
  • A droopy eyelid is a rare but non-serious side-effect of Botox injections.
  • “Eyelid drooping,” or eyelid ptosis as doctors call it, will typically self-correct in a matter of weeks.
  • The problem can be minimized by following certain injection guidelines during the procedure. But even if these guidelines are followed, eyelid ptosis may still occur in some patients.
  • There are treatments available to minimize eyelid “droop” if it happens to you.

Botox is a modern miracle. With a quick injection routine every three to four months, you can stave off eye and forehead wrinkles for years. The procedure is simple and fast, and the effects are nearly instantaneous.

It’s no wonder that Botox is one of the most popular cosmetic procedures in top clinics around the world.

But Botox isn’t without potential problems and side-effects. One rare and unfortunate side-effect is a drooping eyelid, or “eyelid ptosis” as doctors call it.

A drooping, hooded eyelid causes the face to look asymmetrical. Ptosis can be quite unsettling, but thankfully the condition is self-correcting and non-permanent.

If you’re here because you’re experiencing the unpleasant side effects of a “botched” Botox injection, keep reading: we asked four board-certified cosmetic doctors for advice.

Botox Doctors
Dr. Minars, Shainhouse, Stevens, & Potozkin

What Causes Droopy Eyelids After Botox?

The botulinum toxin contained in Botox injections works its magic by causing intentional muscular paralysis in the face. This intentional paralysis prevents the muscles that cause crow’s feet, smile lines and forehead wrinkles from contracting.

Unfortunately, doctors don’t have 100% control over where that toxin goes once it’s been injected into your skin. On rare occasions, it will migrate through the dermis to a muscle above the eye called the levator palpebrae.

This muscle controls the raising and lowering of your eyelid. You can think of the levator palpebrae muscle like a garage-door opener for each of your eyes: when the muscle contracts back and away from the front of your face, your upper eyelids are pulled open.

Unfortunately, if just a little bit of that botulinum toxin comes in contact with one of your levator palpebrae muscles, you’re going to find it impossible to open that eye all the way. This effect is the dreaded “eyelid droop.”

South Florida dermatologist Dr. Todd Minars explains: “The cause of eyelid ptosis is either too much Botox or placing it too close to the eyelid, causing the Botox to migrate into the muscle that gives the eyelid lift and tone.”

There’s an art to applying Botox injections. Experienced doctors have an excellent understanding of facial musculature and make educated decisions on where to inject. By choosing specific locations and depths, they can greatly reduce the potential for subsurface migration of the botulinum toxin.

Board certified dermatologist Dr. Tsippora Shainhouse, a clinical instructor at the University of Southern California, stresses the importance of assessing a patient’s facial muscle movements prior to Botox treatments in order to accurately map injection points.

“When ptosis occurs after Botox injections, it is often because the neurotoxin was injected too low in the frontalis (forehead) muscle, which causes the forehead to ‘relax’ downwards, thus pushing down the upper eyelid.”

What Can Be Done to Avoid Eyelid Ptosis After Botox?

First piece of advice: always visit a board certified dermatologist or plastic surgeon who has experience with Botox and who understands facial musculature.

And don’t settle for generic products, either. Before your procedure, ask your doctor to confirm that the botulinum injections he or she uses are from a well-known, “brand name” manufacturer.

Botox is manufactured only by Allergan. Other excellent products are Dysport, which is manufactured by Medicis, and Xeomin, which is manufactured by Merz. All three of these products have undergone extensive testing and may have more predictable results than no-name, generic products.

Also remember that even if the injections are done with name-brand solutions, in the correct locations, and at just the right depths within the dermis, there’s still a small chance of getting eyelid ptosis. It’s not a permanent condition, fortunately, and it can be treated.

How Long Will a Droopy Eyelid Last After Botox?

So here’s the good news: most droopy eyelids go away on their own after four to six weeks. The bad news is that you’ll be walking around with one of your eyes half-shut all that time.

And sometimes it takes even longer.

As Beverly Hills plastic surgeon Dr. Leslie Stevens explains, “Generally the unwanted effect lasts for less time than the intended one because a lower dose reaches that muscle. If not, it could last for up to three to four months — the same time that Botox lasts.”

The amount of time your ptosis lasts therefore depends on how serious the migration of the botulinum toxin was in the first place, and how much of it actually came in contact with your levator palpebrae muscles.

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What Can Be Done If the Botox Migrated?

If you’re here because the dreaded eyelid droop has happened to you after a Botox injection, there are some things you can do.

First off, eyelid ptosis caused by Botox injections is a rare, temporary condition. Although it can be embarrassing in professional and social situations, it’s not the end of the world.

Talk to your doctor about getting Iopidine (Apraclonidine) eyedrops as a remedy. Iopidine drops reduce the effects of ptosis by causing another muscle in your eye — the Muller’s muscle, which is located next to the levator palpebrae — to seize up and contract. When this happens the eyelid is temporarily forced open — correcting the droop.

Some doctors also recommend additional Botox injections to stimulate different muscles and fix the ptosis.

“There’s no ‘antidote’ for bad Botox,’ says Dr. Shainhouse says. “It has to wear off. However, it’s possible to add Botox to other muscles that may have an opposing effect.”

Shainhouse recommends adding a few units high into the forehead, which may reduce the heaviness of the brow. And a few units added under the tail of the eyebrow “may open the eye a little wider to reduce the ptosis by one or two millimeters.”

Also, it’s worth noting that some patients may think they have eyelid ptosis, when in fact it’s the forehead that is sagging as a result of the injections.

Danville, CA dermatologist Dr. Jerome Potozkin explains: “In some instances the brow can droop when the forehead is injected, resulting in fullness of the eyelids,” says Potozkin. “This is not a true eyelid ptosis. It can be corrected by injecting the muscles with Botox that pull the brow down.”

So How Risky Is Botox, Exactly?

Remember, the chances of getting eyelid ptosis from Botox treatments are very small to begin with. And the chances are extremely small if you’re in the hands of an experienced professional.

“First and foremost, go to a board certified plastic surgeon for your injections,” advises Dr. Leslie Stevens. “Especially for injections around the eyes. No one knows the intimate anatomy of the muscles of the face like a plastic surgeon does.”


Techniques of Cosmetic Eyelid Surgery – A case study approach. Joseph A Mauriello, Jr. M.D. Lippincott Williams & Wilkins

The use of apraclonidine eyedrops to treat ptosis after the administration of botulinum toxin to the upper face. Scheinfeld N, Department of Dermatology, St Luke’s Roosevelt Hospital, New York, USA.

Apraclonidine: A real eye-opener in Botox-induced ptosis. Michelle Crist, O.D. VA Boston Healthcare System – West Roxbury

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