Can I have Botox before Ptosis surgery?

Question

I am due to have repeat Ptosis surgery on my left eye as it didn't work the first time or was not lifted enough. I would like to have some Botox. Will the Botox affect the Ptosis surgery in anyway way or could the surgeon refuse to preform the surgery if I knows I've had Botox?

Tanuj Nakra, MD, FACS · Answer

In short, I would suggest discussing with your ptosis surgeon, and probably deferring treatment until after your ptosis procedure. Botox is a powerful tool that can adjust muscle tone and customized fashion throughout the face. If your Botox treatment is performed near the eye region, the orbicularis muscle can be affected.  The orbicularis muscle is responsible for the lateral eyelid wrinkles – crows feet – and so is a common reason for intended Botox treatments. Botox in this area, weakens this muscle, and can mask underlying ptosis (making things difficult for the ptosis surgeon) because the orbicularis muscle acts as a counter to the eyelid elevating muscle. Hope this is helpful to you – good luck!

James Lee, MD · Answer

I would recommend you wait until the final results of your ptosis surgery. Your physician will be able to better determine what is needed once you have fully healed. Having Botox injections before your surgery can affect the position of your eyelids which can lead to an over or under correction of your ptosis. Be sure to advise your physician before surgery if you have had Botox injections. Good luck. James Lee

James R. Gordon, MD, FACS, FAAO · Answer

Thank you for sharing your question. You should not have Botox injections prior to your surgery (ptosis repair) due to the fact that it could affect what position your eyelid is positioned at during surgery. Discuss this with your doctor. Good luck,

Jeffrey S. Rosenthal, MD · Answer

Botox decreases muscular movement of the forehead.  Often, when the lid or attachments to the lid are weak they require the forehead muscles to assist in lifting it.  It would be best to wait on the Botox until the ptosis surgery and healing phase have been completed.

Michael I. Echavez, MD · Answer

The location on your face that would be treated with the Botox would determine if it might affect your ptosis surgery.  I would recommend discussing this with your ptosis surgeon before getting any Botox and let your surgeon make the decision.

Renuka Diwan, MD · Answer

It is best to avoid Botox before your surgery, and for a few weeks after. Drooping of the upper eyelid can occur after Botox and if it happens to you it can make it difficult to assess how much the eyelid needs to be raised. Your surgeon will advise you, after the surgery, about the best time to have Botox.

William Marshall Guy, MD · Answer

Hello soulboy,I would highly advise you to NOT have Botox before ptosis surgery.  The reason is that if the Botox migrates at all and affects the position of your eyelid, it can negatively affect your surgery.  I would also imagine your surgeon would refuse the surgery until the Botox wore off so the true position of the eyelid can be known.  Correcting ptosis is a difficult procedure as you have seen since your first didn't work.  Adding Botox to the mix would make it that much more difficult.I hope this helps and good luck.

Melissa Toyos, MD · Answer

Please don't. Botox anywhere close to the lid can affect the lid placement, pre-surgical measurements and post-surgical outcome.  Your surgeon needs an accurate reflection of your problem without the addition of Botox.  Trying to calculate probably influence of Botox would be dicey at best and could interfere with your having the best possible results after your surgery.

Robert L. Kraft, MD, FACS · Answer

As much as you would like to have Botox now, it is unwise as it would alter the surgeon's perception of the ptosis. Especially this since is a revision, you want to give it the best chance for success.

Michele S. Green, MD · Answer

I would definitely hold off on Botox for at least three months before your ptosis surgery since this may affect the results of the surgery.  Best, Dr. Green

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