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Solution for One Droopy Eye and One Normal Eye?

Had Botox done 5 d ago by my IM doc. 4 injections in b/t my eyes for a minor wrinkles. I had one noticable wrinkle on the forehead but he said I had more wrinkles on the Rt. Had 4 injections on the Rt side & 1 on the Lt.

Now, my rt eyebrow has dropped causing excess skin on the Rt eye lid. I have to lift up my lid to get eyeshadow on in the morning. The Lt looks good, has an arch & moves w/o causing the forehead to wrinkle. Having headaches on Rt. I RTC on day 7. How can he correct?

Doctor Answers (6)

How to Fix an Improper Botox Treatment

+3

Botox (botulinum neurotoxin type A) reduces wrinkles by the temporary and reversible paralysis of treated muscles. Within 20 to 90 minutes after it is injected, botulinum neurotoxin type A can be detected inside the motor nerve endings. Therefore the muscles and nerve endings take up the Botox very quickly. After that time period, there is no way to reverse the reaction other than letting it "wear off" over three to six months. Returning to the doctor to have more Botox injections to "fix" the problem would be a mistake as things could always be made worse. Please let the effect wear off over time and then seek a different, more experienced physician for your Botox treatments.

 


South Burlington Dermatologic Surgeon
5.0 out of 5 stars 8 reviews

Botox Treats Motion

+3

Unfortunately your doctor didn't understand how Botox works.  Botox can not be adjusted as he did because Botox is fundamentally treating muscle movement; it only indirectly treats wrinkles.  If your muscles in your forward moved symmetrically before your treatment, you have to treat them symmetrically, it doesn't matter what the wrinkles look like.  So by putting more on the right side, it is now weaker than the left and you are thus asymmetric.

Furthermore, he used too much on the dropped side.  Ideally after Botox in the forehead both sides still move some, and the movement is symmetric without any drop of the eyebrow.  Some people do prefer no movement, and that is fine as long as your eyebrows are high at rest.  If your eyebrows are low at rest, too much Botox will force them to stay low all the time.

The only correction that can be done in a situation like this is add more Botox to the left side so it matches the right.  Of course this will make both eyebrows low, but I think that is better than being crooked.  In a few months it will all wear off and you can consider having a proper treatment.

Louis W. Apostolakis, MD
Austin Facial Plastic Surgeon
4.5 out of 5 stars 15 reviews

This person does not know what they are doing.

+3

BOTOX can drop the eyebrow and the eyelid.  However, experienced injector have very few of these types of problems.  This is because very quickly they figure out how to place BOTOX so that this type of problem does not occur.  As you can imagine doing this to a lot of patients will kill your BOTOX practice and your enthusiasm for doing BOTOX.  

What you should do very much depends on what is going on.  Please do not "double down" with the person who did your BOTOX.  If you are a nurse, perhaps you can do a little research among your nurse colleagues and find a good BOTOX injector in your community.  An experienced injector can sometimes balance a treatment.  If all else fails, this treatment will begin to wear off.

Kenneth D. Steinsapir, MD
Los Angeles Oculoplastic Surgeon
5.0 out of 5 stars 14 reviews

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Droopy eye with Botox

+1

Unfortunately I am seeing many patients come into my office who have been injected elsewhere with Botox and are suffering from a droopy eyelid and/or droopy brow.  This typically occurs when an inexperienced injector places too much Botox / Xeomin /Dysport or places it too low or asymmetrically within the forehead.  

I would not recommend correction with more Botox in your instance, rather, allow 3-4 months to resolve the current effects and find an experienced injector so that you will be able to obtain optimal results with less chance of complications.

Best Regards,

Jacque P. LeBeau, MD 

Jacque P. LeBeau, MD
Pensacola Facial Plastic Surgeon
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Asymmetry of the forehead and botox

+1

What you're describing is quite common.  You may have had more lines on the right forehead because the skin of the upper right eyelid has started to sag and come down more than the other side, and your forehead is contracting even when you're relaxed, to lift up the eyelid.  When Botox is injected, the forehead relaxes and looks smoother, but the eyelid skin suffers. The upper eyelid skin now hangs lower than before because the forehead isn't contracting to lift it up. In the future, you will just have to face the fact that botox won't be able to make it perfect.  Some patients who have had similar situations, eventually have a blepharoplasty (eye lift) and can then have more botox in the forehead with less concerns.

Ronald Shelton, MD
Manhattan Dermatologist
5.0 out of 5 stars 31 reviews

Droopy eye after Botox

+1

Often, patients have active forehead muscles because they have a unilateral or bilateral ptosis- a droopy lid due to weakening of the muscle that opens the lid. Raising the forehead with the frontalis muscle helps to open the eye, and also causes wrinkling of the brow. When Botox weakens the muscle, it can no longer raise the brow and the lid becomes droopy. It is also possible that some of the Botox drained into the compartment of the eye that contains the levator muscle, which opens the eye. This usually wears off on about 2 weeks. In the meantime, you can get phenylephrine drops, which will help reduce the droop, although it may blur vision a bit. Your doctor should be able to write a prescription for you.

If you sill notice drooping after 3 months, you should be evaluated for blepharoptosis- the condition caused by the "stretched"  levator muscle. This requires surgery to repair. Remember, the droop was there before the Botox. The Botox just blocks the other eye and brow muscles from correcting for the weak muscle.

Karen Vaniver, MD
Seattle Plastic Surgeon
5.0 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.