Bad Eyelid Droop After Botox, Dr. Said It's Because of Fractured Skull, But I've Never Had An Injury... What's The Cause?

I just had 20 units above my brow now 1 eye is half closed. I look AWFUL & vision is compromised. The P surgeon gave me no post op advice, claiming there was none to give. I have since learned otherwise! He's blaming it on a fracture to my skull he claims I have, though I never had an injury. The over the counter drops aren't working. Will prescription drops work better? Could a fracture cause the Botox to travel? Or is it due to possibly rubbing my brow or sleeping after the treatment? Help :(

Doctor Answers 7

WIth due respect to Dr. Nayak, the drooping can last much longer than 6 weeks.

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You did not supply a photograph so I am presuming that you have developed actual upper eyelid ptosis where the eyelid margin blocks the pupil.  It is also possible to have eyebrow ptosis where the eyelid margin position is normal but the eyebrows are very heavy.  Brow ptosis does not look good but it is generally considered to a less serious problem.  Upper eyelid ptosis after BOTOX occurs when the BOTOX injection results in the agent getting into the orbit and affecting the levator palbepra superioris muscle.  The literature generally suggests this condition lasts a few weeks.  While this is often true, it can also last much longer.  Some cases have lasted as long as 12 months.  I recommend you get assessed by an oculoplastic surgeon.  They can measure and follow the ptosis.  Generally you will be offered Iopodine ophthalmic solution.  This drop can help open the eye.  If you use it and the eyelid responds, your symptoms are likely to resolve in 4 to 6 weeks.  On the other hand, if you do not respond in that first week to the drops, it is much more likely that the ptosis can take 4 to 6 months to resolve and is rare cases even longer.  If you do not initially respond to the drops, once a week you should try them until they do begin to work and then use the product as directed on a daily basis.

If you have never been injured it is ridiculous to suggest that a skull fracture is the basis for your issue.  This is just a way for this doctor to cast responsibility else where and save face.

The American Society for Ophthalmic Plastic and Reconstructive Surgery maintains a geographic directory on their website (asoprs dot org) that will help you find a well qualified surgeon to assist you.

Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

Botox and eyelid droop

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Excessive rubbing could cause the Botox to migrate and diminish eyelid muscle movement. Placing the Botox too close to the eyebrow can also allow the Botox to diffuse and cause the issue you relate. Fortunately the eyelid droop does not usually last as long as the  normal treatment result would. Sorry to hear you had this happen.

Bad Eyelid Droop After Above Brow Botox

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Without Before and After photographs it is impossible to make any comments specific to your situation. I have treated many people with Botox since 1997 and I have never heard of a silent, subclinical skull fracture nor of such a fracture causing botox to sip into the eye orbit. Furthermore, EVERY person getting Botox needs to be told what he / she cannot do. Among the don'ts is vigorous rubbing of the areas around the head toward the upper lid. Doing so may cause the botox to weaken the Levator muscle opening the eye. In addition, there rarely is a need to apply 20 U of Botox just above the Brow. Doing do causes brow sagging with accentuation of upper lid skin.

You may want to get a second opinion from a Botox expert such as a Plastic surgeon or Opthalmologist

Peter A Aldea, MD
Memphis, TN

Peter A. Aldea, MD
Memphis Plastic Surgeon

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How long will eyelid droop last after Botox?

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The good news is that your eyelid droop is NOT permanent.

However, how long it will last is the tricky part...  Eyelid droop is a rare but known complication after Botox. This happens when some of the Botox inadvertently diffuses to the muscle that normally elevates the eyelid -- the levator palpebral superioris.

What can you can do about it?

(1) Eye-drops:  you need to see an experienced physician injector who can examine you to make sure you do indeed have eyelid (and not eybrow) droop. You are likely a candidate for Apraclonidine eye-drops that may raise your eyelid approximately 2mm. (Note: these are prescription, not OTC drops.) In some patients though, there may be no improvement at all and those patients will have to wait for the full effects of the Botox to wear off for the eyelid droop to improve. Since the complete dose of Botox is unlikely to have infiltrated onto your eyelid, the lid droop will likely improve in the next 1-2 months (and not the 3-4 months that Botox normally lasts). Rarely, if more Botox penetrated into the eyelid muscle, the lid droop may last longer...

(2) Post-op regimen: no lying down, massaging or exercise for 6 hours after injection

*A non-existent "fractured skull" has nothing to do with your eyelid droop.

But again, the good news is that it IS reversible and NOT permanent.

A number of things concern me about your treatment: 

(1) Receiving 20 units above your brow -- that puts you at increased risk of eye-BROW droop and possibly migration of the Botox leading to eye-LID droop.

(2) Not receiving any post-injection instructions after your injection -- a physician should always provide you that information.

(3) Blaming the eyelid droop on a sub-clinical skull fracture -- I have never heard or read about such a condition affecting the migration of the Botox and leading to eyelid droop.

I would encourage you to seek the services of an experienced physician injector. I think the key 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, and the patient variability therein. 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 since I commonly dissect under the skin and see the actual muscles themselves. For me, this helps guide where to inject and where not to. However, with that said, I know many Dermatologists who know the anatomy well despite not operating in that area, and get great results.

Good luck.

Botox and eyelid droop

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True eyelid droops are unrelated to drops of the eyebrows. The levator aponeurosis can be affected and may need prescription eyedrops, such as Iopidine, to help lift, to some degree, the eyelid. It will take up to four months to become normal.

Ronald Shelton, MD
Manhattan Dermatologic Surgeon
4.9 out of 5 stars 38 reviews

Eyelid drooping after Botox

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Drooping eyelids are very uncommon with Botox injection.  But, sometimes Botox can migrate in the area from persistent rubbing just after treatment or poor injection technique.  Eyedrops usually help to improve the condition. It  will get better but may take a few months.

Eyelid droop after Botox

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While eyelid droop after Botox is rare, it does occur. This occurs from Botox affecting the eyelid opening muscle.

Most cases I have heard of do not involve any previous fracture. Pressing/rubbing on the area in the first 24 hours can cause the medicine to move, as can injection technique.

The good news - it will mosty wear off by 6 weeks, and drops can help (as can additional Botox into the opposing eyelid muscles, although this is a VERY advanced technique).

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.