Botox injections can cause side effects if not done properly. A good plastic surgeon will start with a lower dose and adjust the dosage to get the desired results. The skill part of injecting Botox is understanding the anatomy of the facials muscle, especially around the eye. It is also critical to inject the right amount of Botox in the right places to avoid side effects. If too much Botox was injected above your eyebrows or if some Botox migrates into the levator palpebrae muscle that elevates the upper eyelid, you will get a lid droop.
Your plastic surgeon should examine your eyes to determine if you have a compensated preexisting eyelid ptosis. In this case, Botox in the frontalis will reveal your eyelid ptosis. If there is no preexisting ptosis then Botox can cause paralysis of the levator palpebrae. 0.5% apraclonidine drops have been used to improve a Botox induced eyelid ptosis (~2 mm elevation) by contracting the Mueller muscle inside the eyelid.
If you are concerned about the possible side effects from Botox, I recommend that you consult with a Board Certified Plastic Surgeon for all plastic surgery on soft tissues around the eye. This includes Botox, Juvederm, Restylane, Eyelid surgery, Browlift and other surgical procedures. Board Certified Plastic Surgeons have over 2 years of comprehensive formal plastic surgery training on the aesthetics, anatomy and function of the soft tissue, muscles and bone around the eye.
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