Upper Eyelid Has Natural Droop. Would Botox Increase Risk of Ptosis?

Hello, I am 24 years old and considering Botox. One of my upper eyelids has a slight natural droop, I believe I have had this since birth. I was wondering if this would lead to an increased possibility of induced ptosis following botox. If so, what is the recommended distance of injection from the affected eye? Thank you in advance, Emma.

Update: 4.27.2012
Hello, I posted previously on the 25th, thank you for all your answers. I've incl. a photo so you can see the slight droop of my right eyelid. I have another question regarding the matter, that is: as I am 24 yrs old I have relatively few wrinkles and I like it this way, hence my interest in getting botox now... am I right in assuming the younger you get botox (within reason) the better the effects? Or are you better to start later to avoid "over-botoxing" ? Thanks in advance.

Doctor Answers 10

Here's how you can tell if you are at risk for botox induced ptosis

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Let's say you have a little natural droop to your upper eyelids. First figure out, is it really droopy, or do you just have extra skin? if you look at yourself in the mirror, the edge of the upper eyelid should only be 1 or 2 mm - in other words just a little bit - overlapping the iris, or the colored part of the eye. If it is all the way down to the pupil (the dark part) then you have real ptosis. Most ptosis is called "mechanical", should be fixed, and is covered by insurance plans, as an fyi.

Some people keep their eyebrow muscles lifted all the time to actually keep their eyelids up. Seriously. If you completely relax your brow, and your eyelids droop, DON'T PUT BOTOX IN YOUR FOREHEAD! Your underlying ptosis will worsen because you can no longer compensate. Capiche? Even "normal" patients will notice lots of forehead botox drops their eyebrows down, saying it looks "heavy" and their upper lids looks worse.

If you just botox your glabellar areas (the "11") it shouldn't affect your underlying ptosis. In fact, botoxing the glabella and the outer brow (the part of the orbicularis oculi that lowers the brow) can actually help lift the eyebrow. None of these will directly affect the upper lid unless your injector accidentally sticks it too close to the eyelid itself. Be careful and go to someone reputable and you can get a great result.

Beverly Hills Plastic Surgeon
4.7 out of 5 stars 16 reviews

Botox and eyelid droop

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It is rare in cosmetic Botox injections to get ptosis because the injection sites are sufficiently far from the levator muscle that raises the eyelid.  Having an eyelid droop shouldn't increase your risk of this side effect. 

Matheson A. Harris, MD
Salt Lake City Oculoplastic Surgeon
5.0 out of 5 stars 6 reviews

Botox rarely causes ptosis

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Botox rarely causes eyelid ptosis, though it can happen. You did not mention what problem you wanted to treat. Many areas commonly treated with Botox pose no risk of ptosis. An experienced injector can evaluate your concerns and help you decide if Botox is for you.

Daryl K. Hoffman, MD
San Jose Plastic Surgeon
4.6 out of 5 stars 16 reviews

Upper Eyelid Has Natural Droop. Would Botox Increase Risk of Ptosis?

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 I agree that at 24, I'd like to see you and be sure that you really need Botox or Dysport injections to soften unwanted lines and wrinkles.  If the Botox or Dysport is injected too close to the eyebrows, they will drop which would also increase the droop of the upper eyelid(s). 

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.7 out of 5 stars 28 reviews

Upper Eyelid with a Natural Droop and Botox

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Hello.  At 24 years old I'm wondering if you truly need Botox!  However, without seeing you it's hard to tell.  There is a way to actually lift the brow with Botox so that may improve your natural eyelid droop.  Please go to a very competent injector as this can be a tricky problem to correct.  One would not want to make it worse.

Sheri G. Feldman, MD
Beverly Hills Dermatologist

The answer is a definite maybe.

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On the one hand no, because experienced injectors have very low rates of inducing upper eyelid ptosis.  On the other hand, if you use your forehead to help open the droopy eyelid (look for a raise eyebrow over the droopy eyelid), then forehead BOTOX may very well weaken the forehead muscles and cause a worsening of the droopy eyelid that is being supported by the brow.

Kenneth D. Steinsapir, MD
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

Botox and eyelid droop

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You are wise to ask this question.  The risk of ptosis depends on the area being treated.  If you are treating your crow's feet, there is no concern for a droop.  If you are treating your frown lines or forehead lines, there is a small chance that could happen.  You can minimize that by seeing an expert injector, preferably a board-certified dermatologist or plastic surgeon.  This is a not a time to look for the best deal.  After all, this is your face.  Your doctor will use some special techniques to maximize your results and minimize the chances of side effects.  It can be done.  See an expert.

Peterson Pierre, MD
Thousand Oaks Dermatologist
4.3 out of 5 stars 6 reviews

Botox can cause complications with eyelid droop

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Rarely, Botox is injected and the upper eyelid droops over the iris of the eye.  This can be due to the forehead drooping and pushing the upper eyelid down with it, or it can be caused by the levator muscle of the upper eyelid being relaxed. The latter can occur when the Botox is injected immediatley above the eyebrow, or within 1 cm. (about 2/5 of an inch)  in the vertical line that runs through the pupil. 

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

Botox and eyelid drooping

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Contrary to what most people are lead to believe, when Botox is administered correctly, it very rarely causes direct eyelid drooping. If you truly have an eyelid deformity called ptosis, in some cases your forehead muscles can be compensating for this eyelid malpostion/weakness and when you then weaken the muscles in your forehead with the Botox, a heavier, more sagging upper lid can be the side effect. This is one of the reasons it is so important to first consult with a trained and experienced Professional prior to having this done.

Droop of eyelid/brow and Botox

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Asymmetry of the brow and upper eyelid region is common.  Conserative treatment using Botox can be performed to minimize the risk of excessive descent of the brow.  Go to an experienced injector.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 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.