Ask a doctor

I Recently Had Botox Injection to Forehead and Now my Eyelids Hang over My. Eyes,will This Be Permanent?

Doctor Answers 9

Heavy Eyelids after Botox

Hi LW.  Not to worry, this will correct itself after a short period of time.  One of the side effects of Botox injections is Ptosis.  This normally happens with less experienced injectors as injection technique and amounts are important in avoiding this problem.  We suggest you visit your injector to see if they can help with the problem by doing a "chemical browlift", but if you do not have confidence in your injector or they don't normally offer this service then it may be best to just wait.  Good luck.

Los Angeles Facial Plastic Surgeon
5.0 out of 5 stars 6 reviews

23211 Hawthorne Blvd.
Torrance, CA 90505

Botox is temporary

The mixed blessing of botox is that it is completely temporary. Your droopy eyelids will improve as the botox wears off. Your heavy eyelids are either from too much botox in the frontalis resulting in eyebrow droop or from botox traveling to the levator palpebrae superioris muscle resulting in a weak eyelid muscle. The former (heavy eyebrow) will improve as the botox wears off, but the latter (weak eyelid muscle) should improve within the next few weeks and can be improved with eyedrops called iopidine. I would revisit your injector to determine the cause of your droopy eyelid. Good luck! 

Ramona Behshad, MD
Saint Louis Dermatologic Surgeon
5.0 out of 5 stars 6 reviews

1001 Chesterfield Pkwy E
St. Louis, MO 63017

Eyelids hanging over eyes after Botox treatment...

I am unsure if you are experiencing eye-LID droop or eye-BROW droop that can sometimes cause skin gathering over your eyelid to mimic eye-LID droop. 

Rest assured, both are temporary complications of Botox and WILL improve.

Let's discuss both in more detail....

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

Mark K. Markarian, MD, MSPH
Chestnut Hill Plastic Surgeon
5.0 out of 5 stars 4 reviews

25 Walnut St
Wellesley, MA 02481

Low brows

Fortunately with Botox injections this look will not be permanent. This occurs when the forehead is overtreated and the brows drop. It is usually when people have horizontal wrinkles on their forehead and want to get a smoother forehead. The frontalis muscle elevates the eyebrows and causes the forehead wrinkles. By placing Botox in the muscle and over-weakening it the eyebrows will drop. This is an indicator that a browlift may be in your future if you want to have a smoother forehead. Rest assured though, your eyebrows will come back their normal position. Best Wishes. 

Manuel A. Lopez, MD
San Antonio Facial Plastic Surgeon
5.0 out of 5 stars 37 reviews

1314 E. Sonterra Blvd
San Antonio, TX 78258

I Recently Had Botox Injection to Forehead and Now my Eyelids Hang over My. Eyes,will This Be Permanent?

 No, Botox lasts about 3 months and the eyelids will return to how they looked before the injections.  Injecting Botox too close to the eyebrows causes the brows to droop which makes the upper eyelid more full.  Have a more experienced Botox injector next time to avoid that from happening.

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.5 out of 5 stars 12 reviews

8500 Wilshire Blvd
Beverly Hills, CA 90211

Botox causes the brows to fall

Botox weakens muscles. When injected in the forehead, it weakens the forehead muscle. That can cause the forehead/brows to fall in those people that have underlying droopy brows. The effect is temporary since Botox effect is temporary (about 3 months). You can consider forehead/brow lift in the future to address the underlying problem.

Mehryar (Ray) Taban, MD, FACS
Beverly Hills Oculoplastic Surgeon
5.0 out of 5 stars 21 reviews

9735 Wilshire Blvd
Beverly Hills, CA 90212

Heavy eyebrows after Botox will resolve

Heavy brows after Botox is related to:  too low an injection, too much Botox, or unrecognized brow problems before injection. Many doctors are tempted to inject foreheads which have a lot of creases but don't realize that the patient needs to lift brows to keep excessive overhanging lids from obstructing their vision.  If they inject these people, they will have a wrinkle free patient but an angry one because of low lids/brows. Best to give very little or nothing to these patients. In all case this gets better though. 

Steven F. Weiner, MD
Panama City Facial Plastic Surgeon
4.5 out of 5 stars 9 reviews

2050 W County Highway 30A
Santa Rosa Beach, FL 32459

Droopy lids after Botox

I agree with Dr. Cohen's comments.  There are also drops that can be placed in the eye (iopidine) to  reduce the symptoms of droop while you are waiting for the Botox to wear off if the levator muscles of the eyelid are involved.  The effects of the Botox should begin to get less noticeable in 4-6 weeks.  Hope this helps.

Marilyn Pelias, MD
New Orleans General Surgeon
5.0 out of 5 stars 12 reviews

311 Octavia Street
New Orleans, LA 70115

Botox and droopy eyebrows

Botox works by temporarily relaxing muscles.  If you have horizontal lines across your forehead, that get worse when you lift your brows, then Botox can help those lines.  The problem is that the muscles being treated are the same ones that lift your brows.  Treatment in that area takes a good deal of skill.  The key is getting the right dose injected in the right places so that the proper muscle balance is maintained.  The good news is that Botox is always temporary so this problem will wear off over a period of a few weeks to a few months.  You may want to ask your doctor if there is a way to adjust the treatment so your brows sit a little higher now.  Sometimes injection properly given under the eyebrows can cause a little lift.  Hope this is helpful.

Marc Cohen, MD
Philadelphia Oculoplastic Surgeon
5.0 out of 5 stars 16 reviews

50 Monument Road
Bala Cynwyd, PA 19007

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.