Robert C. Langdon, MD

"Droopy eyelid" after Botox or Dysport injection is the result of an inadvertent paralysis effect on the levator palpabrae muscle, a small muscle that serves to elevate the upper eyelid. This problem is very rare when experienced physicians administer the injection (the last time this happened in one of my patients was in 1999). It usually occurs after Botox injection in the frown line area (glabella). The levator palpabrae muscle is located somewhat deep below the surface of the lid; if a small amount of Botox diffuses in this area it may weaken the muscle. The key to avoiding this unwanted side effect is for the physician to keep any injections near the middle portion of the eyebrow at least a few millimeters above the brow.

If weakness of the levator muscle does occur, it can be alleviated by the use of eye drops (Apraclonidine) that stimulate another small muscle that can also lift the lid. The effect of the Botox will wear off after 3-4 months.

"Droopy eyelid" should not be confused with a sagging eyebrow, which can result if too much Botox is used in the forehead, weakening the muscle that lifts the brows (frontalis muscle).