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Why Have I Gotten Ptosis TWICE from Botox? Is It Me?

In the past 3 years, I have gotten botox injections 5 times. The first 3 went great, terrific results. Then, 2x in a row, once w a nurse injector and once w a well known plastic surgeon I got the dreaded eyelid droop. Both times I got the droop, I was injected in my crow's feet area, but I've been told that this area wouldn't be the culprit. Prescribed drops cleared it up, but for 2 wks I was in dark glasses! Am I just a poor botox candidate?

Doctor Answers (14)

Ptosis with Botox


It is possible to get ptosis after a Botox treatment, but you are correct in that this does not normally occur after treatment to the crow's feet.  In order to get a droop, the Botox needs to be placed above the upper eyelid.  I don't know for sure, but the only logical explanation would be that your issue was due to the placement of the Botox.  I would not say that you are a poor candidate, but perhaps your injectors need to be extra careful in not placing any Botox too high on you.  

San Francisco Facial Plastic Surgeon
5.0 out of 5 stars 14 reviews

Ptosis after Botox to Crow's Feet?


Hi db.  It would be unusual and highly unlikely to have eyelid ptosis after injecting the crow's feet.  Unless the procedure was done very poorly twice in a row, it would be very hard to see how ptosis could occur.  

With that said, there is some value to visiting the same injector.  Once they get to know your facial anatomy and how you respond, it becomes much easier to determine the right amount and placement.  Good luck.

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

Ptosis following Botox injections


Drooping of the eyelid is one of the rare but potential side effects of Botox. It can occur even when very experienced injectors perform the treatment. However, experience and proper technique are essential to minimize the chances of eyelid ptosis occurring. In general, an eyelid ptosis will not occur if the injections are performed in the area of your crow's feet, unless they were unusually high. Fortunately, drooping of the eyelid following a Botox treatment is temporary. The issue will usually resolve in around two weeks, sometimes sooner depending on the patient. In the future, I would recommend discussing the history of your issue to the physician performing your injections. You are not necessarily a bad candidate, it is likely just a rare coincidence that ptosis occurred with consecutive treatments. Thank you, and I hope this helps!

Paul S. Nassif, MD
Beverly Hills Facial Plastic Surgeon
5.0 out of 5 stars 34 reviews

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Ptosis after Botox


Since your had great experiences with Botox in the past, it's not likely that you are a poor botox candidate. Did you had the same areas injected each time? Every physician has his or her own injection techniques. If you developed ptosis then it's typically an unintended muscle that was affected by the Botox. Go back to the physician who gave you great Botox experiences. There are significant anatomical variations among individual patients that even Botox injection requires skills, experiences and a thorough understanding of facial anatomy.

Best Wishes,

Stewart Wang, MD FACS, Wang Plastic Surgery

Stewart Wang, MD, FACS
Los Angeles Plastic Surgeon
4.5 out of 5 stars 24 reviews

Ptosis from Botox


Ptosis, or a drooping eyelid, can happen from Botox injections.  It usually occurs either when Botox is placed too low on the forehead (too close to the eyebrow).  The other scenario where this occurs is when the patient has very heavy eyelids to start and uses their forehead to lift their eyebrows and eyelids.  When the forehead is relaxed with Botox, the patient cannot lift their eyebrows to keep the eyelids raised, which results in a "droop."  It is not common to have ptosis from Crow's feet injections.  Careful placement of Botox and injecting small amounts can help avoid these problems. 

Donna Bilu Martin, MD
Miami Beach Dermatologist

Ptosis after Botox


It is unlikely that Botox injection in the crows feet would cause ptosis.  It is more likely that injection in the brow or forehead would cause eyelid ptosis (or unmask an underlying eyelid ptosis).  See an oculoplastic specialist for evaluation.

Mehryar (Ray) Taban, MD, FACS
Beverly Hills Oculoplastic Surgeon
4.5 out of 5 stars 12 reviews

Botox and eyelid ptosis


Typically when eyelid ptosis occurs, it's injector related. If any of the product is allowed to leak down into your eyelid, you will have ptosis until the product wears off. You're not a poor candidate, but you do need to make sure your injector is well-trained and experienced, and knows you've had this issue in the past.

Sam Naficy, MD
Seattle Facial Plastic Surgeon
5.0 out of 5 stars 144 reviews

Botox and ptosis


The ptosis is caused by the placement of the Botox and should not happen if only the crow's feet were injected.  Please return to your injector so he can see the result and plan to alter placement of the injections next time.

Martie Gidon, MD, FRCPC
Toronto Dermatologist
5.0 out of 5 stars 16 reviews

Ptosis and Botox for crow's feet


It is very interesting that you experience ptosis after having your crow's feet treated with Botox.  I am having a hard time explaining this based on the location of the injections.  The placement would have to be very high, within the upper eyelid or in the eyebrow for this to happen.  I have provided you an article where in over 2000 crow's feet injections (1000 patients) eyelid ptosis was not reported.  But there was a slight risk of developing upper lip ptosis (3 out of the 1000 patients).  What drops were prescribed?  I'm not sure how that would help.  Ptosis from Botox injections usually resolves spontaneously in 1-2 weeks.

Curt Samlaska, MD
Las Vegas Dermatologist
5.0 out of 5 stars 2 reviews

Eyelid droop after Botox


Botox injections to the crow's feet do not cause eyelid ptosis unless you were rubbing your eyes vigorously just after injection and it affected you levator  muscle of your eyelid.  Lateral brow ptosis is possible with injection of the brow just above the eyebrow.

Steven Wallach, MD
Manhattan Plastic Surgeon
4.5 out of 5 stars 17 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.