What to Do with Droopy Eyelids After Botox?

Thank you for your question.

Although rare, droopy eyelid (eyelid ptosis) after Botox treatment is one of the most common potential side effects of treatment and is not permanent. Botox causes eyelid ptosis by migrating into one of the muscles that holds up the eyelid (levator palpebrae superioris). The good news is this muscle tends not to be affected by Botox for as long as the typical muscles Botox targets which is generally three to four months. If your provider determines you are a good candidate, apraclonidine eyedrops may be added to speed up recovery time and stimulate the muscle in the eyelid itself (superior tarsal muscle) causing it to contract and raise the eyelid. Adding this treatment may allow for the eyelid to return to its normal position in a few weeks.

For expertise on injections and management of complications visit the office of a Board-Certified Plastic Surgeon.

I hope this helps.

Eyelid drooping after neuromodulators like Botox, Dysport or Xeomin is a rare but well described issue, usually resulting from product placement or the amount used. 
The first thing that needs to be determined is whether it is a droopy eyebrow or truly a droopy eyelid. Droopy eyebrows are much more common and result from immobilizing the only muscle on the forehead that is able to lift up our eyebrows. Droopy eyelids come from the product getting into the wrong muscle that elevates the eyelid. 
Management of them is quite different, but both have strategies to help expedite resolution while waiting for them to resolve with time, and any experience injector should be very familiar with how to deal with them: drops for the eyelids and precise placement of Botox in the brow depressors when it is an eyebrow issue. 
To ensure you are receiving the highest level of care, seek out a modernly trained, new-school dermatologic surgeon, oculoplastic surgeon, facial plastic surgeon or plastic surgeon who is board certified and fellowship trained in one of these "core four" cosmetic specialties. Membership in organizations like the American Academy of Facial Plastic and Reconstructive Surgery help to identify a highly trained surgeon.
Cameron Chesnut#realself500 Physician

Thank you for your question. Sorry to hear about the droopy eyes. It sounds like you are experiencing ptosis of the eyelids and brows. They eyelid portion can be partially corrected with the use of eye drops. Your physician would need to prescribe it. It will also wear off as the effect of Botox wears off.  Laser treatment will not help.

Lets discuss each symptom separately.(1) A drooping eye-BROW may happen when the brow-elevating muscle in the forehead, the Frontalis, receives too high a dose of Botox, or alternatively, if the Botox is sub-optimally placed. Of note, it may also happen if you have a low set eyebrow to begin with, in which case any Botox to the Frontalis increases the likelihood of a brow droop. A droopy eyebrow from Botox can sometimes be improved with Botox injected into the outside part of the eye (the lateral aspect of the orbicularis oculi muscle) to generate a bit of a brow lift in that area -- by injecting more Botox and paralyzing the orbicularis muscle that normally acts to depress the brow in that area, you may get a slight compensatory brow lift...(2) A droopy eye-LID may occur if the Botox is injected too close to your eyelid-elevating muscle, the levator palpebra superioris. In such a scenario, the Botox will diffuse inadvertently onto the levator muscle and cause an eyelid droop. You may have an increased risk of eye-LID drooping if you have a weakened upper eyelid muscle for neurological reasons, or a deeply set eye-BROW that would be more prone to drooping (as discussed above) and result in skin gathering over the eyelid making the eyelid appear like it was drooping. A droopy eye-LID due to Botox can be treated with Apraclonidine eye-drops which can provide a small (2mm) improvement -- Apraclonidine 0.5, 1-2 drops, 3 times per day. Make sure you put in one drop at a time, tilt your head back, and close your eyes to make sure none of the eye-drop leaks out. Be sure your prescribing physician discusses all the potential side-effects of the drops, such as "adrenaline-like" symptoms like anxiety or heart pounding; you may also experience eye irritation, eye dryness, and eye pain, amongst other symptoms. If these symptoms occur, you will likely need to take some lubricating eye drops, lower the dose, switch the eye-drops, or stop the drops altogether...In the future, be sure to seek the services of an experienced physician injector. I think the key with Botox lies in truly understanding the anatomy of the injected area, and more importantly the variability in the anatomy between patients -- for brows, the forehead, and anywhere else you plan on receiving a Botox injection. This includes having a firm understanding of the origin, insertion, and action of each muscle that will be injected, the thickness of each muscle targeted, and the patient variability therein. As an aesthetic-trained plastic surgeon, I am intrinsically biased since I operate in the area for browlifts and facelifts, and have a unique perspective to the muscle anatomy since I commonly dissect under the skin and see the actual muscles themselves. For me, this helps guide where to inject and where not to. However, with that said, I know many Dermatologists who know the anatomy well despite not operating in that area, and get great results.Good luck.Dr Markarian

Dear Mimi
Your BOTOX treatment was a little too much.
However, you need a real doctor. As others have pointed out, the laser treatment is nonsense.
With all do respect to Dr. Salas, his message regarding board certified plastic surgeons is also not helpful and is probably unethical according to the bylaws of his own society. Oculoplastic surgeons who are board certified ophthalmologists and are fellowship trained in oculoplastic surgery have the largest body of experience treating eyelids with BOTOX and the most experience with Iopodine, the drop that helps lift the eyelid. The ASOPRS website at ASOPRS.org has referral information to help you locate an oculoplastic surgeon near you.
Regrading how long this effect will last, it if often stated to last a few weeks. This is commonly true. However, the ptosis can also last much longer. I recently completed a study of patients with long term ptosis after BOTOX. Here is the key. If you use the drops and the eyelid opens up, your ptosis will last 4 to 6 weeks. If the eyelid does not respond to the drop, then the ptosis can last 3 to 6 months and possibly longer.
Finally, understand that it can be emotionally devastating to have the face dysfunctional following BOTOX. I have seen patients who have been unable to work and depressed until the effect wears off. It will wear off but it can be a very long road.

A rare side effect of Botox is droopy eyelids (blepharoptosis). Droopy eyelids were seen in 3% of patients in the pivotal studies and they occur in less than one half of 1% of patients in my experience. Droopy eyelids usually occur when treating the frown lines between the brows and it occurs if some of the Botox spreads from that area to a nearby muscle which lifts the eyelid. This side effect is temporary and treatable. Without treatment droopy eyelids normally resolve within two to four weeks after your Botox treatment. You can also use prescription eye drops (apraclonidine or Iopidine) twice daily which improves the droopy eyelids significantly. I have not seen improvement of droopy eyelids with laser treatments. Good luck!

There is a eyedrop solution called Lopidine that can strengthen a small muscle that helps raise the eyelids. Aside from that, a couple of units of Botox can be injected just below the sides of the eyebrows that can help lift that part of the eyelid/eyebrow. If you had nothing done, chances are within 4-6 weeks, you would notice improvement in the drooping and by 3-4 months, it will have resolved completely. Laser treatments are unlikely to help with your problem.
Good luck.

Unfortunately, you have been given Botox too close to the eye, and this has resulted in weakness of the muscle that helps open the eyelid (AKA the Levator Muscle).
You can use an eye drop (Naphcon-A) to help open the eyelid by activating another muscle (AKA the Muller's Muscle).
As you know, Botox generally lasts about 3-4 months. Fortunately, the effect of Botox on the Levator Muscle is shorter than it is in other areas. You should begin to see improvement within a couple of months.
Botox is a a safe product that can achieve excellent results in the hands of a properly trained plastic surgeon.
Good luck with your treatment.

Botox lasts three months -- your droopy lids will go away. I do not believe that the laser is doing anything to help. Only time can cure your problem.

The hard truth is that the botox is already in your tissues and working like it is supposed to. Unfortunately, it is in the wrong spot. Laser will have no effect.
You will have to tough it out. Fortunately, it will likely only last a few more weeks. I am sorry that you are experiencing this, but the good news is that it is not permanent.
Hang in there.
sek