Botox gave me droopy eye lid again! Why did this happen?

Question

I've been getting botox on my forehead for 2 years now. I got my first eyelid droop a few months ago. I waiting for all the Botox to wear off and decided to go to a new injecter. I told her my issue about the droopy eye and we went down to 15 units. I'm 1 week post injections and again I'm getting an eyelid droop. Should I stay clear from Botox on my forehead? Why did this happen again?

Otto Joseph Placik, MD · Answer

Hi you should contact the place where they did the treatment to see what they recommend and see why this is happening.The effects of Botulinum Toxin (Dysport or Botox) on the eyelid muscles causing droop (blepharotposs) can last several months. Occasionally the most dramatic effects are during the first 2 weeks. Other than Lopidine another product is Alphagan (brimonidine tartrate 0.2%) .These are products that can help,but I recommend seeing the person that did the treatment.

Joseph J. Castellano, MD · Answer

In addition to the amount of product used, the precise placement of your BOTOX injections is a primary factor in seeing optimum results. If you've experienced no previous issues with BOTOX until now, you might want to take a break from treatments for a bit. I'd also suggest visiting a different injector, preferably a cosmetic surgeon who is highly experienced with injectables, to get a second opinion. Best of luck to you.

Steven H. Williams, MD · Answer

Hello,Thank you for sharing your question.It's important to clarify whether you have an eyelid droop or an eyebrow droop. These can both happen with incorrect placement of the product or diffusion to a surrounding muscle. It's also possible that you have some existing eyelid ptosis and weakening the frontalis muscle caused the eyelid droop to become more apparent since you cannot compensate as well by raising your eyebrows.I recommend seeing an experienced board-certified injector that can assess your specific facial features and musculature prior to treatment.Hope this helps!

Kenneth D. Steinsapir, MD · Answer

The issue is not the botox but how the botox is being administered.  I recommend you find an injector who know something about oculoplastic surgery.  Consider having my Microdroplet Lift procedure.  The reference below has a physician directory that can help you find an injector who performs this technique.

Jason Emer, MD · Answer

This may be due to Botox placement. Keep in mind, it can take 1-2 weeks for final results with Botox and the results resolve in 3-4 months. If you're unhappy with your final results, venus legacy and thermage treatments can soften results. See an expert. Best, Dr. Emer

Rod J. Rohrich, MD · Answer

The key to doing Botox in any area of face is the experience and expertise of the injector to perform this in a safe manner without causing eyebrow or eyelid drop or any other sequelae.  It is imperative that one select someone with the experience and expertise of the neuromodulator being used whether Botox, Zeomin or Dysport.  The key is to be sure your injector is a board certified plastic surgeon, facial plastic surgeon, dermatologist or oculopastic surgeon with expert knowledge in the science of facial aging and facial anatomy.

Nodas Kapositas, MD, PhD · Answer

Botox injections must be done by a board certified plastic surgeon who knows better than anyone  the anatomy of the area. Droopy eye can happen if the fluid spreads after the injection.We use a specific techique to avoid this possibility.In that case we use iopidine eye drops as long as required.

Carlos l. Sierra, DDS · Answer

Unfortunately we have no re versing agent for Botox so it could be very annoying for the pts affected with ptosis waiting for the effects of Botox  to wear off . In my nine years of injecting Botox I've only had one case of ptosis and it was definitely from injecting too close to the eyebrow. I  would approach this case slowly placing Botox at least 1 cm if not more above eyebrows and  with fewer units waiting two weeks following up with the patient and incrementally add more Botox if necessary until  the desired results is achieved.

Dean P. Kane, MD, FACS · Answer

Dear JessJessie:Your injector(s) must understand the anatomy of the area for proper injection technique. If the Botox needle reaches the bone, the medicine will slide along a plane directly to the eyelid muscles. Consult with a Board Certified Plastic Surgeon who is talented and experienced in this seemingly simple but as you point out, complicated procedure.All the best!

Shaun Patel, MD · Answer

Sorry to hear about your experience. Honestly, it's hard to comment without seeing a photo or evaluating you in person. There is a difference between eyelid ptosis and eyebrow ptosis and so that would be the first thing to determine. Too high a dose in the forehead and placement too close to the eyebrow can both lead to eyebrow/eyelid ptosis. Some patients have a baseline ptosis (droopiness) and maybe dependent on the forehead muscle to keep the eyelids open. In this case, relaxing the forehead muscle with Botox or Dysport could lead to worsening of the eyelid ptosis (droopiness). I recommend you followup with your injector to discuss your results and to determine if anything can be done to correct the ptosis.

Botox gave me droopy eye lid again! Why did this happen?

Answers (17)

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