Raised Eyebrows and Drooping Lid After Botox

Hi Shara. Unwanted effects related to botox treatment are always temporary and will resolve with time. Unless the area of your concern received a full treatment of botox directly, unintended effects of treatment typically resolve within weeks. Discuss your concerns with your doctor. In some cases, overly raised brows may be addressed with additional botox treatment to the brow elevators. Until the effects of the botox wear off, the eye drops that you are using may help to improve the drooping eyelids. Good luck.

Thank you for your question. Sorry to hear about the droopy eyes. It sounds like you are experiencing ptosis. It is something that can be partially corrected with the use of eye drops. Your physician would need to prescribe it. It will also wear off as the effect of Botox wears off.

Let me start by saying your symptoms are likely NOT permanent and will improve to their pre-injection state.(1) Your first complaint about the raised eyebrows are likely referring to your lateral brows (outside areas).  Typically the Frontalis muscle that serves to elevate your brow may not have been adequately targeted in that area -- the simple solution would be to receive a little more Botox in that area to improve symmetry.(2) Your second complaint, a droopy eye-LID, can be treated with Apraclonidine/Iopidine eye-drops which you already have.  These may provide a small (2mm) improvement. Make sure you put in one drop at a time, tilt your head back, and close your eyes to make sure none of the eye-drop leaks out.  Be sure your prescribing physician discussed all the potential side-effects of the drops, such as "adrenaline-like" symptoms like anxiety or heart pounding; you may also experience eye irritation, eye dryness, and eye pain, amongst other symptoms. If these symptoms occur, you will likely need to take some lubricating eye drops, lower the dose, switch the eye-drops, or stop the drops altogether...In the future, be sure to seek 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, 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.- Dr Markarian

All very good, thorough input from the panel members. Although the use of Botox is the number one aesthetic procedure done worldwide, there are potential negative outcomes that may occur. Consumers should be proactive in finding a practitioner that is experienced, skilled, and stays current with techniques.
As the panel members suggested, Botox must be precisely placed with precise doses. Many consumers don't realize that Botox in one area may cause a reaction or unintended result in a non-treated area. This is often the case when one has overactive, arched brows (aka: Jack Nicholson eyebrows) or a heavy brow, heavy upper eyelid, etc.
Be certain to discuss with your injector your concerns so that they may make a proper assessment and recommendation.

Too much Botox into the obicularis oculi muscle can cause drooping eyelids and raised eyebrows several ways. The raised eyebrows are due to frontalis compensating of the eyelid ptosis and paralysis of the obicularis side of the antagonistic muscle pair.
If you did not have preexisting compensated eyelid ptosis, your eyelid ptosis is probably due to botox paralysis of the levator palpebrae. Additional eyelid ptosis is probably due to the inability of the frontalis to fully compenstate through a flaccid obicularis muscle.
The 0.5% apraclonidine drops can partially help (~2 mm elevation) by contracting the Mueller muscle inside the eyelid. Unfortunately, it takes more than 4 weeks for the significant improvements you are looking for.

Dear Shara I just completed a study of 7 patients who developed severe ptosis after BOTOX. Generally upper eyelid ptosis or drooping after BOTOX is rare and resolves within 4 to 6 weeks. These 7 individuals were more unusual in that their ptosis persisted for 7 or more weeks and in one case lasted a full year. In these individuals Iopodine was initially ineffective. The Iopodine only became effective about 4 to 6 weeks before the drooping of the upper eyelids wore off. Consequently, if the Iopodine is working and makes your upper eyelid look better, then the droopiness is likely to wear off in about a month. If the Iopodine is not working, your upper eyelid ptosis may take 3 to 6 months before resolving. The reason your eyebrow is elevating is to compensate for the heavy eyelid. This will get better. Keep using the Iopodine and the next time you are treated, do not let the doctor treat you so close to the eyebrow.

Shara,
It sounds like you had an unfortunate outcome with Botox. Beside the Iopidine drops, which should help lift your lids a few millimeters, there really is not much that you can do. The good thing is that Botox is always temporary. For your raised brows, you can have them inject a small about of Botox (3 units) 1 cm above the lateral brow. Good luck with your recovery.

These are well recognised side effects of Botox.Some people have a very over active and powerful forehead muscle whose outer half is powerful. Botox tends to weaken the inner half or inner 2/3 of the forehead, this may lead to unbalanced activity of the outer 1/3 of forehead muscle causing eyebrow elevation. A droopy eyelid after Botox too is a well recognised side effect. You probably have a weak upper eyelid that is droopy. When you have a droopy eyelid the forehead muscle over compensates and lift the eyebrow and indirectly lifts the eyelid. When you inject Botox into the forehead, you weaken this effect and the net effect is a droopy eyelid.

Botox works to paralyze muscles of animation. Most commonly it is used to treat the frontalis muscle of the forehead to erase wrinkles. Some doctors inject areas under the eyebrow to elevate it. However, it can accidentally cause eyelid drooping to do injection of the orbicularis oculi muscle. This should get better with time as the Botox wears off, and the eye drops should help as well.

Dear Shara,
It sounds like some of the Botox migrated to the muscles that effect your upper eyelid. Lopodine may help but it may take some time (a few weeks) until you begin to see results. As the Botox begins to wear off, you will also notice an improvement. In these instances, I recommend patience and not doing anything drastic. You should not have any long lasting effects.