What to Do with Droopy Eyelids After Botox?

Lets discuss each symptom separately.(1) A drooping eye-BROW may happen when the brow-elevating muscle in the forehead, the Frontalis, receives too high a dose of Botox, or alternatively, if the Botox is sub-optimally placed. Of note, 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. A droopy eyebrow from Botox can sometimes be improved with Botox injected into the outside part of the eye (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...(2) A droopy eye-LID may occur if the Botox is injected too close to your eyelid-elevating muscle, the levator palpebra superioris. In such a scenario, the Botox will diffuse inadvertently onto the levator muscle and cause an eyelid droop. You may have an increased risk of eye-LID drooping if you have a weakened upper eyelid muscle for neurological reasons, or a deeply set eye-BROW that would be more prone to drooping (as discussed above) and result in skin gathering over the eyelid making the eyelid appear like it was drooping. A droopy eye-LID due to Botox can be treated with Apraclonidine eye-drops which can provide a small (2mm) improvement -- Apraclonidine 0.5, 1-2 drops, 3 times per day. 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 discusses 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

Dear Mimi
Your BOTOX treatment was a little too much.
However, you need a real doctor. As others have pointed out, the laser treatment is nonsense.
With all do respect to Dr. Salas, his message regarding board certified plastic surgeons is also not helpful and is probably unethical according to the bylaws of his own society. Oculoplastic surgeons who are board certified ophthalmologists and are fellowship trained in oculoplastic surgery have the largest body of experience treating eyelids with BOTOX and the most experience with Iopodine, the drop that helps lift the eyelid. The ASOPRS website at ASOPRS.org has referral information to help you locate an oculoplastic surgeon near you.
Regrading how long this effect will last, it if often stated to last a few weeks. This is commonly true. However, the ptosis can also last much longer. I recently completed a study of patients with long term ptosis after BOTOX. Here is the key. If you use the drops and the eyelid opens up, your ptosis will last 4 to 6 weeks. If the eyelid does not respond to the drop, then the ptosis can last 3 to 6 months and possibly longer.
Finally, understand that it can be emotionally devastating to have the face dysfunctional following BOTOX. I have seen patients who have been unable to work and depressed until the effect wears off. It will wear off but it can be a very long road.