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Bad Eyelid Droop After Botox, Dr. Said It's Because of Fractured Skull, But I've Never Had An Injury... What's The Cause?

I just had 20 units above my brow now 1 eye is half closed. I look AWFUL & vision is compromised. The P surgeon gave me no post op advice, claiming there was none to give. I have since learned otherwise! He's blaming it on a fracture to my skull he claims I have, though I never had an injury. The over the counter drops aren't working. Will prescription drops work better? Could a fracture cause the Botox to travel? Or is it due to possibly rubbing my brow or sleeping after the treatment? Help :(

Doctor Answers (6)

WIth due respect to Dr. Nayak, the drooping can last much longer than 6 weeks.


You did not supply a photograph so I am presuming that you have developed actual upper eyelid ptosis where the eyelid margin blocks the pupil.  It is also possible to have eyebrow ptosis where the eyelid margin position is normal but the eyebrows are very heavy.  Brow ptosis does not look good but it is generally considered to a less serious problem.  Upper eyelid ptosis after BOTOX occurs when the BOTOX injection results in the agent getting into the orbit and affecting the levator palbepra superioris muscle.  The literature generally suggests this condition lasts a few weeks.  While this is often true, it can also last much longer.  Some cases have lasted as long as 12 months.  I recommend you get assessed by an oculoplastic surgeon.  They can measure and follow the ptosis.  Generally you will be offered Iopodine ophthalmic solution.  This drop can help open the eye.  If you use it and the eyelid responds, your symptoms are likely to resolve in 4 to 6 weeks.  On the other hand, if you do not respond in that first week to the drops, it is much more likely that the ptosis can take 4 to 6 months to resolve and is rare cases even longer.  If you do not initially respond to the drops, once a week you should try them until they do begin to work and then use the product as directed on a daily basis.

If you have never been injured it is ridiculous to suggest that a skull fracture is the basis for your issue.  This is just a way for this doctor to cast responsibility else where and save face.

The American Society for Ophthalmic Plastic and Reconstructive Surgery maintains a geographic directory on their website (asoprs dot org) that will help you find a well qualified surgeon to assist you.

Los Angeles Oculoplastic Surgeon
5.0 out of 5 stars 17 reviews

Botox and eyelid droop


Excessive rubbing could cause the Botox to migrate and diminish eyelid muscle movement. Placing the Botox too close to the eyebrow can also allow the Botox to diffuse and cause the issue you relate. Fortunately the eyelid droop does not usually last as long as the  normal treatment result would. Sorry to hear you had this happen.

James M. Kurley, MD
Champaign Plastic Surgeon
4.5 out of 5 stars 17 reviews

Bad Eyelid Droop After Above Brow Botox


Without Before and After photographs it is impossible to make any comments specific to your situation. I have treated many people with Botox since 1997 and I have never heard of a silent, subclinical skull fracture nor of such a fracture causing botox to sip into the eye orbit. Furthermore, EVERY person getting Botox needs to be told what he / she cannot do. Among the don'ts is vigorous rubbing of the areas around the head toward the upper lid. Doing so may cause the botox to weaken the Levator muscle opening the eye. In addition, there rarely is a need to apply 20 U of Botox just above the Brow. Doing do causes brow sagging with accentuation of upper lid skin.

You may want to get a second opinion from a Botox expert such as a Plastic surgeon or Opthalmologist

Peter A Aldea, MD
Memphis, TN

Peter A. Aldea, MD
Memphis Plastic Surgeon
5.0 out of 5 stars 63 reviews

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Botox and eyelid droop


True eyelid droops are unrelated to drops of the eyebrows. The levator aponeurosis can be affected and may need prescription eyedrops, such as Iopidine, to help lift, to some degree, the eyelid. It will take up to four months to become normal.

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Drooping eyelids are very uncommon with Botox injection.  But, sometimes Botox can migrate in the area from persistent rubbing just after treatment or poor injection technique.  Eyedrops usually help to improve the condition. It  will get better but may take a few months.

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Eyelid droop after Botox


While eyelid droop after Botox is rare, it does occur. This occurs from Botox affecting the eyelid opening muscle.

Most cases I have heard of do not involve any previous fracture. Pressing/rubbing on the area in the first 24 hours can cause the medicine to move, as can injection technique.

The good news - it will mosty wear off by 6 weeks, and drops can help (as can additional Botox into the opposing eyelid muscles, although this is a VERY advanced technique).

Laxmeesh Mike Nayak, MD
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These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.