Botox Drooping Eyebrow Permanent?

3 months ago I had botox which caused drooping of one eyebrow. Although I now have what seems to be full movement back suggesting the botox has worn off, the eyebrow still droops regularly especially when I'm tired. I think it may be permanent and have read similar stories where it has never gone. Please help. Also will facial exercises help to raise drooping brows or is this a myth? Any other ways I can help myself? Thanks.

Doctor Answers 22

Droopy eyebrow after Botox

Eyebrow drooping after neuromodulators like Botox, Dysport or Xeomin is a rare but well described issue, usually resulting from product placement or the amount used. 

The first thing that needs to be determined is whether it is a droopy eyebrow or a droopy eyelid. Droopy eyebrows are much more common and result from over-immobilizing the only muscle on the forehead that is able to lift up our eyebrows - choosing the right amount and placement in the right patient is key to good forehead results. Droopy eyelids come from the product getting into the wrong muscle that elevates the eyelid. 

Management of them is quite different, but both have strategies to help expedite resolution while waiting for them to resolve with time, and any experience injector should be very familiar with how to deal with them: drops for the eyelids and precise placement of Botox in the brow depressors when it is an eyebrow issue. 

To ensure you are receiving the highest level of care, seek out a modernly trained, new-school dermatologic surgeon, oculoplastic surgeon, facial plastic surgeon or plastic surgeon who is board certified and fellowship trained in one of these "core four" cosmetic specialties. Membership in organizations like the American Academy of Facial Plastic and Reconstructive Surgery help to identify a highly trained surgeon.

Cameron Chesnut
#realself500 Physician

Spokane Dermatologic Surgeon
4.9 out of 5 stars 104 reviews

Can Eyebrow Droop after Botox be Permanent?

The good news is your symptoms are likely temporary and WILL improve. Facial exercises and other similar activities will not significantly help -- only time will...

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

Botox drooping eyebrow permanent?

Botox lasts for 3 months on average, and sometimes longer depending on the patient. Botox is not permanent, and any associated side effects should wear off when the Botox does. To help improve the ptosis, apraclonidine eye drops can be used. Apraclonidine is an alpha-andrenergic agonist eye drop. It can cause the muscles to contract, elevating the upper lid. I would recommend speaking with your provider about this option. If necessary, you may also speak with a board certified opthamologist or oculoplastic surgeon. I hope this helps, and I wish you the best of luck.

Paul S. Nassif, MD
Beverly Hills Facial Plastic Surgeon
4.7 out of 5 stars 47 reviews

Drooping after Botox

The good news Botox is temporary. Since Botox can last 3 to 4 months you are probably very close to the end of your problem. It could last as long as 6 months. You also may not realize you may have had some assymetry prior but didn't really notice it until you started your treatments. Actually, most people have some assymetry. The Botox should finish wearing off in the near future.

Esta Kronberg, MD
Houston Dermatologic Surgeon
5.0 out of 5 stars 29 reviews

For better or worse - botox is temporary

For some people "temporary" can be as little as 2 months, and for others  - as long as six months. With repeated use some people are able to see a prolongation of the benefits by a few weeks.

It sounds like your undesirable effects are about ready to disappear since it has been 3 months, and the effect is waning - especially noticeable when you are tired.

So don't give up. And keep in touch with your doctor to assure that this was a learning experience, not to recur. 

Christopher J. Peers, MD
South Bend Facial Plastic Surgeon
4.6 out of 5 stars 5 reviews

Re: Botox Drooping in Eyebrow

Droopiness can occur if excess amounts of Botox was used.  This is a compound that blocks the release of acetylcholine from the nerves. Without this signal, your muscles will stay relaxed, as you have experienced. However,  as your body metabolizes this chemical, it no longer binds to the acetylcholine release sites. This may take a little while, longer if you are still experiencing some droopiness. However, this is just temporary as the other doctors have noted.



Sanusi Umar, MD
Redondo Beach Dermatologic Surgeon
4.6 out of 5 stars 32 reviews

Drooping after Botox for Forehead Lines and Crow's Feet

Thank you for the great question. Botox is temporary. For most patients, the effects last between 3 and 4 months. But for some patients, the effects may be up to 6 months. This will also depend on the dose used. Since you can actively move the muscles, it is likely that you are close to regaining the baseline level of strength required to hold up the brow. This can help to explain why you notice the difference more when you're tired. Regardless, it is important to see your physician to keep him or her informed of the situation and your progress.

Evan Ransom, MD
Bay Area Facial Plastic Surgeon
4.9 out of 5 stars 110 reviews

Botox and eyelid droop

Botox is temporary, and doesn't cause permanent drooping of your eyelid. Is it possible you never noticed the change in your eyebrows? Visit the link below for all side-effects and to read about cosmetic Botox.

Sam Naficy, MD, FACS
Seattle Facial Plastic Surgeon
4.7 out of 5 stars 221 reviews

The Drooping 3 Months After Botox Injections Will Resolve

Be patient and all will be well. This is still the "temporary" effect from the Botox. You have regained movement but not full strength. Unfortunately, there are no exercises that will help. Hang in there. It will be okay soon.

Michael R. Menachof, MD
Greenwood Village Facial Plastic Surgeon
4.4 out of 5 stars 26 reviews

Eyebrow droop after Botox/Dysport is not permanent: muscles and "constitutive" tension.

Armstrong, your eyebrow works "actively" now but will soon work "passively" too. What's happening is that you are able to actively flex the muscle to lift the eyebrow, but there is still enough active Botox that when at rest, and when you are tired, the natural underlying "constitutive" tension of the muscle is still overwhelmed by the remaining reduction in live receptors. Your body will slowly regenerate the neuromuscular receptors over the next few months and eventually even when you are tired, the eyebrows will be just as even as they were before Botox.

Jessica J. Krant, MD, MPH
New York Dermatologic Surgeon
4.7 out of 5 stars 41 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.