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Should I Be Concerned That Botox Could Cause Eyebrow Drooping?

I want to use botox injection to treat the very shallow horizontal forehead lines and the very deep frown lines between my eyebrows. I've heard that forehead lines injection run a bigger risk of eyelid drooping. Should I just treat the deep frown lines between my eyebrows to avoid eyelid drooping?

Doctor Answers 26

Go ahead and have Botox in the glabella and forehead just go to an experienced MD

 Everything has risks, including Botox injections to the forehead.  However, you can mimimize these risks by going to an MD that has experience using Botox in the forehead.  I've used Botox to soften lines and wrinkles of the face and forehead for over 20 years and there are ways to inject the Botox so it has very little chance of dropping the eyebrows.  Just remember that "you get what you pay for" and if you shop around for a cheap price on your Botox, you may indeed wind up spending less and getting a dropped eyebrow(s).


Beverly Hills Facial Plastic Surgeon
4.5 out of 5 stars 12 reviews

Should I be concerned that Botox could cause eye-BROW and eye-LID Drooping?

Short answer -- NO; you should be able to treat both the forehead lines and the deep frown lines safely with minimal risk of any complications if you are treated by an experienced physician injector.  Please read on for more details...

Your question concerns two known, but rare complications of Botox -- eye-LID droop and eye-BROW droop...

(1) A drooping eye-BROW may happen in the following scenarios:

-- When the brow-elevating muscle in the forehead, the Frontalis, receives too high a dose of Botox.

-- The Botox is sub-optimally placed too low in the forehead -- it should typically be placed at least 1 cm above the Brow.

-- Over-injection of the glabella area (between the brows).

-- 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.

Ironically, a droopy eye-BROW from Botox can sometimes be improved with MORE Botox -- this time, the Botox is typically injected into the outside (top of the crow's feet) part of the eye (aka 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...

If the extra Botox does not improve the brow droop, it will likely last as long as the full duration of the Botox -- 3-4 months.

(2) A droopy upper 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. Typically, a lower dose diffuses onto the levator muscle and so the other good news is that the eyelid droop will typically NOT last as long as the full Botox duration of 3-4 months, and may in fact resolve in less than a month. Note however that if the eyelid droop occurs shortly after injection (i.e. within 3-4 days), then your eyelid levator muscle likely received a significant dose of Botox and your eyelid droop may not resolve for 1-2 months...

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 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...

Again, please 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, how deep beneath the skin the actual muscle resides, 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, see the actual muscles themselves, and learn "first-hand" the incredible variability between patients -- live, "on the OR table" -- as opposed to via lectures or a cadaver dissection. For me, this helps guide where to inject and where not to. However, with that said, I know many non-aesthetic trained plastic surgeons and other physicians who know the anatomy well despite not operating in that area, and get good results.

Good luck.

Dr Markarian

Botox for frown lines and forehead lines

you may indeed benefit from the glabellar lines being treated betweent the eyebrows but it may be that the horizontal lines, once treated, would prevent the lift your forehead needs to prevent your upper eyelids from falling down naturally. You would need to be examined to determine your candidacy for horizontal forehead line treatment with Btoox.

Ronald Shelton, MD
Manhattan Dermatologic Surgeon
5.0 out of 5 stars 33 reviews

Go to an experienced injector and you should be fine

As long as you go to an experienced Botox injector, they will know where to place the botox and how to make sure you do not get eyelid brow drooping.

Babak Azizzadeh, MD
Beverly Hills Facial Plastic Surgeon
4.5 out of 5 stars 5 reviews

Misplaced Botox can cause drooping.

Eyebrow drooping is a possibility when Botox is misplaced (i.e. too much in the wrong areas), that is why it is so important to trust your doctor.


When you are ready to undergo any esthetic procedure, it is best to have a consultation with a board certified cosmetic doctor or dermatologist who you trust. They will give you the honest answers for your unique situation (your starting point, your objectives and your budget).


At the Victoria Park Medispa, we take off the consultation fee from any appointment booked, therefore reducing a client’s risk of having a treatment performed without taking the time to think about what they really want. Any esthetic tool needs to be in the right hands, to achieve the best possible results.

Steven Bernstein, MD
Montreal Dermatologic Surgeon
5.0 out of 5 stars 5 reviews

Botox

Forehead injections usually can effect eyebrow drooping more than eyelid drooping.  Injections higher on the forehead with less units can help wrinkles and minimize the drooping of the brow.  The lighter touch however may improve the wrinkles but not completely remove them.  I hope this info helps.

Ronald H. Stefani Jr, MD
Chicago Plastic Surgeon
5.0 out of 5 stars 2 reviews

Botox and risk of eyelid drooping

Thank you for your question. Many patients have heard about the risks of eyelid drooping with Botox treatment and would like to understand more about that. It is prudent both to consider and to be concerned about the potential risks of any treatment. Precisely because there are risks, I recommend that patients only consider receiving Botox treatments from well-trained professionals. Because the forehead treatment area can be close to the upper eyelids, some of the Botox can diffuse through the tissues to affect the muscles that act to raise your eyelid. When performed by a trained physician with experience, that risk is very low. When eyelid drooping does occur, it is temporary. Because the upper eyelid muscle receives only a fraction of the total Botox dose (only the amount that diffused), the eyelid drooping typically resolves in less than a few weeks. I sometimes suggest to patients who are considering a first treatment with Botox to choose just one area. You should see an experienced physician for a consultation. In your case, you might choose to try just the area between your eyebrows. If you are satisfied and would like to try another area, perhaps your experience with your first treatment will provide you with more comfort and confidence about taking that step - both in terms of the Botox and your physician. Good luck.

James M. Pearson, MD
Los Angeles Facial Plastic Surgeon
5.0 out of 5 stars 53 reviews

Botox great for forehead

Get it done! YES that is a side effect but make sure you Go to a professional! Make sure it is either plastics or Derm--we have had much training and experience.

Tracy Kuykendall, MD
Tulsa Dermatologist
4.0 out of 5 stars 5 reviews

How to Avoid Eyelid Droop with Botox?

Hi MzShizuka.  To avoid drooping you should find an experienced injector.  The rate of ptosis (eyelid or eyebrow droop) is extremely low for an experienced Botox injector.  

Do your homework now and choose someone carefully and you will likely avoid the ptosis issue.

Harold J. Kaplan, MD
Los Angeles Facial Plastic Surgeon
5.0 out of 5 stars 6 reviews

Can Improper Botox Treatment Cause Eyebrow Drooping?

Botox relaxes and weakens the muscles within which it is placed. The forehead muscles (FRONTALIS) lift the brows and in so doing cause the horizontal lines across the forehead. Depending on the depth of the lines and the natural sagginess of the brows care must be used in the application of Botox to the forehead to weaken the lined formation WITHOUT dropping the brows.

This is one of the reasons why you should have your Botox done by a Plastic surgeon / Dermatologist rather than a salon / spa injector. A huge number of the saggy brow, weird frozen faces of "Bad Botox" are related to WHO did the Botox.

To fully understand your options read the link below.

Dr. Peter A Aldea

Peter A. Aldea, MD
Memphis Plastic Surgeon
5.0 out of 5 stars 81 reviews

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.