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Dropped Eyelids and Eyebrows After Botox Treatment 29 Units?

Botox Results: Very little movement of my eyebrows can't the lift the side of eyebrows, lids are dropped over my crease, and getting stuck. Now I look old, sad and still frown. M.D inyected me in top of the middle of my eyebrow. Is this a normal technique for frown lines only? What went wrong and how to fix it? Please do not respomd if you don't have a technical answer.

Doctor Answers 12

Botox Brow Droop

Brow droop can happen.  First, it is important to know what dilution ratio was used- as this affects size of the area of dispersement.  Second- in patient's that have a history of brow droop with Botox, have your provider target all the depressors first (glabella- Corrugator muscles, Procerus Muscle) and Crowsfeet (Orbicularis Oculi Muscle)-- then re-asses in 2 weeks for a light forehead injection if needed to get rid of horizontal forhead lines.  By weakening all the depressors first, you will get a brow lift. Third, in order to improve this right now, eyedrops are an option but only affect the eyelid margin itself and not the upper eyelid skin (speak with your provider about this) and make sure your depressor muscles are weakened sufficiently so that these are completely out of the equation-- so that the forehead elevator can pull up on your brows.  Fourth- have patience and trust your provider-- we have all had this happen from time to time.


Austin Plastic Surgeon
5.0 out of 5 stars 5 reviews

Don't like Botox results

I inject into the top middle of the eyebrow, but that's usually for a full treatment where I am treating the forehead and the glabella area (the 11's between the brows). However, there are different muscles that cause the glabella area to crease and create those lines which you are referring to as "frown lines", so sometimes I will inject a few units into the middle upper ridge of the eyebrow too, but this is after I have people manipulate their faces so I can see where the muscle strains creating the lines. Botox can and should be customized somewhat to each individual, and while I would say that a normal treatment for the glabella (frown lines) for me would be 25 units, I will place those units differently for each patient I'm injecting. With you, it sounds like the injections into your brows have caused you to get some brow ptosis. This means the brow is pushing down onto your eyelids, which is creating your creasing and sticking. Also, the injection may have made it so that the outer portion of your eyebrow has fallen too. There are three options: 1. Time will fix it. Botox isn't permanent, so your results will start to fade and be gone over 3-4 months. 2. I don't know where you live and there are very few people with this technology in the U.S., but you can find someone who has a machine with galvanic energy (ours is called a PanGerminal System) that makes muscles move. It was originally highlighted as a workout for the face, but what it's even better at is fixing Botox issues for specific muscle areas and people who have been overinjected around the mouth area with Botox. I use it on many problem cases that come to my office for help. It forces the muscles to work by putting galvanic energy only into that spot. It basically makes your Botox wear off in that specific area only and forces the muscle to re-work. Again, when I got this machine like a decade ago, there were like 5 of us who had it nationally. 3. You can see someone who is qualified and fixes a lot of Botox problems. By injecting into countering places from what you have now, some of those depressed areas may be able to re-lift a bit. I realize that getting more Botox is probably not what you want to do right now, but it can help.

F. Victor Rueckl, MD
Las Vegas Dermatologist
4.5 out of 5 stars 9 reviews

Botox and droopiness eyebrows

It sounds like it diffused and causing droopiness of your eyebrow and eyelid and the combination is altering your vision -  frown lines is above the bridge of th enose in between the eyebrows. Be patient, it will take time, but it will go away.

Dropped Eyelids and Eyebrows After Botox Treatment...

I can't speculate as to how your injector treated you, but I can talk about both conditions -- droopy eye-LID and droopy eye-BROW -- and how to try fixing both...

A Droopy Eye-LID

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. A lower dose typically 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 occurred 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 or more...

On a side note, 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. During your consultation, your injecting physician should rule out both of these scenarios to ensure you are an appropriate candidate for Botox... Your thyroid disease is not a contraindication to Botox or to the treatment of your eyelid droop, which brings me to my next point...

A droopy upper eye-LID due to Botox can be treated with Apraclonidine (aka Iopidine) eye-drops. These eye-drops are commonly used to improve Gluacoma – a condition of high “eye ball pressure”. However, besides lowering the pressure in the eye, Apraclonidine causes the Muller muscle in the upper eyelid to contract and lift the upper eyelid about 2mm.The usual dose of Apraclonidine 0.5% is 1-2 drops, 3 times per day until the Botox wears off. (Note, 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.) Apraclonidine should be used with caution in patients taking Beta-blocker eye drops (ex – Timolol), or certain pills for high blood pressure (such as Beta-blockers), Digoxin, and those taking MAO inhibitors (ex – Phenelzine) for Depression. Be sure your prescribing physician also discusses 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...

A Droopy Eye-BROW

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

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

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

(3) 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, as mentioned above, 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 (and even possibly restore some of your natural eyebrow arch)...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.

When it comes to Botox, I would recommend seeking, at the very least, 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. So, what kind of physician should be injecting your Botox? 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 as 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

In regards to your droopy eyelids, it sounds like the Botox is impacting on the muscles in your upper eyelid - where it wasn't meant to be injected.  You should see a board certified physician in your area that uses Botox for cosmetic purposes often.  They can provide you with eyedrops that can help counteract this effect on your upper eyelids.

 

In regards to your droopy brow - it's going to take 3-4 months for this to improve.

Asif Pirani, MD, FRCS(C)
Toronto Plastic Surgeon
5.0 out of 5 stars 31 reviews

Post Botox droop

It sounds like you are very sensitive to this treatment of might have had a little too much. Brow droop  has to do with forehead treatment. Less to the forehead would avoid that next time. Lid droop can occur because some botox has gotten to where we do not want it. This can be be corrected with eye drops. Patients that have loose upper lid skin to begin with are at more risk for these problems.

Jo Herzog, MD
Birmingham Dermatologist
5.0 out of 5 stars 13 reviews

Brow drop after Botox

Unfortunately you will have to wait for the Botox to wear off. When injecting, if the brow appears heavy I will not always treat the lowest wrinkles to avoid this. However, this can not always be accomplished. This is a good reminder for next time to remind your doctor to not give it so low.  Sometimes I inject the lateral orbicularis to raise the lateral eyebrow.

Steven Wallach, MD
Manhattan Plastic Surgeon
4.5 out of 5 stars 18 reviews

How to prevent brow drop with Botox

The position of the brows is determined in large part by a balance between the muscles that elevate it and the muscles that pull it down. When the brow begins to drop, there is often a compensatory response by the muscles that lift it, which in turn causes the horizontal forehead lines (this is called "frontalis hyperactivity"). The temptation is to treat the lines with Botox, which will make them go away but then there is nothing holding the brow up. So it takes judgment, and often it is important to inject the brow depressors also in those instances. Your own injector should be able to evaluate and advise, and of course your situation may be different.

Richard Baxter, MD
Seattle Plastic Surgeon
5.0 out of 5 stars 33 reviews

Low brows and eyelids after botox

Treatment must always be tailored to the patient's specific requests.  There are two distinct areas of the forehead that Botox helps: the frown lines between the eyebrows (glabellar lines) and the crosswise forehead lines caused by raising the eyebrows.  The glabellar area is treated by 16-20 units of Botox with care to place the most lateral two injections at least one fingerbreadth above the inner end of the eyebrow.  This avoids the potential for the medicine to migrate into and paralyze the lifting muscles of the eyelid (levator muscles) which would cause the lids to sag (ptosis).  If this happens, the ptosis of the lids can sometimes be treated with eyedrops called Nafcon A applied four times a day until the Botox wears off.  If the transverse (crosswise) forehead lines are to be treated, the Botox is placed in the elevated folds in about four vertical rows using about 1-2 units per injection.  It is best to avoid the lower forehead (the area of about one to one and a half fingerbreadths above the upper edge of the eyebrow) in order to avoid drooping of the eyebrows.  It is better to have a few lines above the eyebrows than to have the eyebrows sagging.  The good thing is that ill effects of Botox are always temporary.  Botox is a great product if it is targeted to the specific problem the patient has and one stays away from the danger areas to avoid problems. 

Fredric D. Schuh, MD
Charleston Plastic Surgeon
4.5 out of 5 stars 2 reviews

Eyebrow droop after Botox

Without photographs it is hard to make any definite assessment.  If you have concerns after any procedure, I would always recommend touching base with your injector/surgeon to make sure he is aware of the situation and can make specific recommendations for you.

 

That being said,  29 Units is a reasonable dose for the glabella area, which is the area with the "11's," the vertical lines between the eye brows.   If the medicine relaxed your forehead (frontalis) muscle too much, it will cause a droop in the brows.  Especially if you  have some pre-existing drooping of the upper eyelid skin and brows, even a little bit of drooping from the Botox will cause an undesirable result.  This can be prevented by paying attention to your appearance before the injection, perhaps adjusting the dose, and taking care to place the injections such that the medicine won't diffuse into adjacent muscles.

 

Keep in mind that it will get better in 3-4 months, regardless of how droopy things might be now.  Hang in there and good luck.

Michael Bowman, MD
Montgomery Facial Plastic Surgeon
5.0 out of 5 stars 9 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.