Eyebrow Droop After Botox?

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

Patients who have concerns about their treatment should see the provider that performed the treatment to analyze the effect of the Botox and see if their is more of a forehead lowering pushing down the eyelid, or an actual upper eyelid droop from temporary weakening of the levator muscle. The peak effect of Botox is between a week and two and should not look any worse after this time. Any weakening should be fully resolved by four months, and usually it looks close to normal by 12 weeks.If the doctor diagnoses a levator weakening, there can be improvement by a couple of mm. of elevation by using a prescription eyedrop. If the forehead muscle is weakened in areas very low near the eyebrow, by Botox placement there, the doctor may see how much activity is still present in the muscles that normally pull down on the forehead and if these muscles haven't completely been relaxed then more units in those muscles will help the forehead elevate more and, in turn, pull up on the eyelid.

Eyebrow 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 a droopy eyelid. Droopy eyebrows are much more common and result from over-immobilizing the only muscle on the forehead that is able to lift up our eyebrows - choosing the right amount and placement in the right patient is key to good forehead results. 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

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

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 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.

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.

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!

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.

The Botox will wear off gradually, and depending on the dosage injected into your brow, you will begin to see movement of your brow and improvement of your brow ptosis (droop) before 3 months.  Sometimes injecting Botox in the lateral orbicularis (muscle that opposes the frontalis muscle, which lifts your brows) will allow the brow to be slightly lifted, and less ptotic (droopy).  

I would recommend a follow up with the physician who injected your Botox. Drooping of the brow is a potential side effect that may occur even if your injections are performed properly. Botox lasts for three months on average, and any side effects you are experiencing will wear off around this time. I hope this helps, and best of luck to you.