Ask a doctor

Eyebrow Droop After Botox?

32 years old. Think I'm experiencing eyebrow droop. Had 25 units I think in 11s and forehead. Have lateral movement in one side so eyebrow lifts at side but barely any movement in other and this side is dropping the worst. The eyebrow is dropping over the eyelid around 3mm and there is excess skin. Nearly 11 days in to treatment is this likely to get worse or do you think botox is at peak? Is there anything I can do or will I have to wait 3-6 months. Will it wear off gradually? Please help

Doctor Answers (16)

Asymmetry of Brow and Eyelid Position after Botox- What To Do?

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Thanks for asking about Botox and your results.  Here are some tips to head you in the right direction:

1.  don't panic, it will wear off gradually

2.  return to your doctor so that she may see your result, quantify the amount of units used, note it in your record and take this into account at your next treatment. 

3.  your doctor will be able to determine if any additional touch up or ancillary treatment will improve the situation

4.  often times it is not the eyelid that is actually drooping. Rather it is the relaxation of the forehead muscle that leads to the eyebrow shifting downward. This small shift can be enough to crowd the upper eyelid skin and give the appearance of a lower seated eyelid.  It's important for your doctor to make this distinction which is why a follow up visit may give you some assurance.

3.  everyone's face is asymmetric and successful Botox treatment requires an understanding of the facial anatomy, the subtle difference from one side to another and an adjustment of injections accordingly.

Thanks for asking!  Ellen Mahony, MD


Westport Plastic Surgeon
5.0 out of 5 stars 13 reviews

Brow droop after Botox...

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
Botox usually takes 7-10 days to achieve full effect, so your eyebrow droop is unlikely to get worse.

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.

You have two options:

(1) Wait 3-4 months for the Botox to wear off.

(2) Receive more Botox to specific muscles to counteract the 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...

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

Drooping Eyebrow After Botox

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
A rare side effect is temporary drooping of one eyelid. This is short lived and is quite uncommon in the hands of an experienced injector. Eyelid droop may also be corrected with a prescription eye drop (Iopidine 0.5%) that you can get from a physician. This can help alleviate the droop within a few weeks to a month. However, you can also wait it out as it will subside gradually.

Eyebrow Droop after Botox

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

   Eyebrow droop after Botox can be avoided if the Botox is injected well above the brow.   Should you obtain this result, additional Botox to the orbicularis oculi rather than the frontalis may be able to improve the ptosis depending upon relative muscle bulk and strength.

Eyebrow Droop After Botox

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

If you have unwanted decent of your eyebrow after botox this effect can be counteracted by having botox placed around the eye (at the tail of your eyebrow).  This may seem counterintuitive but when you inject botox in the forhead the muscle that helps to lift brow (frontalis m.) is weakened so this results in the decent of the forehead.  There exists another muscle which encircles your eye (orbicularis oculi m.).  You can think of this muscle as the one used when you squint from the sunlight.  By weakening this muscle in the area of the tail of the eyebrow you prevent the additional pulling down of the brow, allowing your brow to lift slightly.

Anthony Bared, MD
Miami Facial Plastic Surgeon
5.0 out of 5 stars 30 reviews

Eyebrow droop after Botox?

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Sorry to hear about the side effects you are experiencing following treatment. In general, Botox may result in:

1) Minor bruising
2) Minor swelling
3) Ptosis of the brow and/or eyelid

The good news is that the effects of Botox are temporary. A drooping brow usually improves after a few weeks, and this can be helped along with eye drops prescribed by your physician if necessary. At this point, the condition will not likely get worse. Improvement is usually gradual, but depends on the patient. I would recommend a follow up with your physician, as he/she may provide you with advice and treatment options. Thank you and good luck!

Botox and eyelid ptosis

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Yes, you do have options to help while the Botox wears off, if you have true eyelid ptosis, and following up with your provider should help educate you on what those are. Eye drops either OTC or prescribed are often very helpful.

Sam Naficy, MD
Seattle Facial Plastic Surgeon
5.0 out of 5 stars 152 reviews

Botox and eyebrow droop

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

The droop is caused by Botox injected into your forehead.  Even a tiny amount of Botox can cause this droop if you have very dynamic forehead lines.  Please return to your injector so he can see the result.  He may be able to even out your movement until the Botox effect wears off in a few months.  He will then know how to inject you next time.

Martie Gidon, MD, FRCPC
Toronto Dermatologist
5.0 out of 5 stars 18 reviews

Touch-up Botox may be needed

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Your practitioner may be able to fix the problem, so a follow up visit is a good idea. The one-sided drooping of your eyebrow can be fixed with a little touch up Botox injected into the eyebrow on the affected side. This weakens the muscle that pulls down the eyebrow, and allow the muscle that lifts the eyebrow to work without competition. Your injector should make a note of this, so that he/she can make adjustments to prevent this from happening again at your next injection.

Ramona Behshad, MD
Chesterfield Dermatologic Surgeon
5.0 out of 5 stars 5 reviews

Eyebrow Droop after Botox Will Wear Off

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Eyebrow droop or brow ptosis after Botox is the result of overtreatment of the forehead (frontalis) muscle, the only muscle that can lift the eyebrows. If you already overuse and rely on your forehead muscles to keep your brows up because of already "saggy" upper eyelids, then treatment of forehead lines should be very conservative.

Eyebrow droop wears off fairly quickly and can also be improved by adding filler under the brows to lift them. In fact, using filler in the temples and brows is becoming more and more common. If you are not comfortable with fillers, then treatment with a radiofrequency device like the Pelleve (pain fee and no down time) can lift and tighten the skin and improve the droop. Every patient is different and there is no "cookie-cutter" treatment that works for everyone.

The key to successful treatment with Botox, Dysport and Xeomin is to go to an expert injector who knows what the intended action of every muscle is. The goal of treatment is to balance the actions of elevator and depressor muscles. That means that the central part  of the upper forehead may be treated at the first session to allow the sides of the forehead to lift the eyebrows.  The sides of the forehead can be treated 2 weeks later if the eyebrows are overcompensating and looking pointy or overarched.

Vivian Bucay, MD, FAAD
San Antonio Dermatologic Surgeon
4.0 out of 5 stars 5 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.