Dropped Eyelids and Eyebrows After Botox Treatment 29 Units?

Brow droop can happen.  First, it is important to know what dilution ratio was used- as this affects size of the area of dispersement.  Second- in patient's that have a history of brow droop with Botox, have your provider target all the depressors first (glabella- Corrugator muscles, Procerus Muscle) and Crowsfeet (Orbicularis Oculi Muscle)-- then re-asses in 2 weeks for a light forehead injection if needed to get rid of horizontal forhead lines.  By weakening all the depressors first, you will get a brow lift. Third, in order to improve this right now, eyedrops are an option but only affect the eyelid margin itself and not the upper eyelid skin (speak with your provider about this) and make sure your depressor muscles are weakened sufficiently so that these are completely out of the equation-- so that the forehead elevator can pull up on your brows.  Fourth- have patience and trust your provider-- we have all had this happen from time to time.

I can't speculate as to how your injector treated you, but I can talk about both conditions -- droopy eye-LID and droopy eye-BROW -- and how to try fixing both...A Droopy Eye-LIDA droopy upper 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. A lower dose typically diffuses onto the Levator muscle and so the other good news is that the eyelid droop will typically NOT last as long as the full Botox duration of 3-4 months, and may in fact resolve in less than a month. Note, however, that if the eyelid droop occurred shortly after injection (i.e. within 3-4 days), then your eyelid Levator muscle likely received a significant dose of Botox and your eyelid droop may not resolve for 1-2 months or more...On a side note, 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 and result in skin gathering over the eyelid making the eyelid appear like it was drooping. During your consultation, your injecting physician should rule out both of these scenarios to ensure you are an appropriate candidate for Botox... Your thyroid disease is not a contraindication to Botox or to the treatment of your eyelid droop, which brings me to my next point...A droopy upper eye-LID due to Botox can be treated with Apraclonidine (aka Iopidine) eye-drops. These eye-drops are commonly used to improve Gluacoma – a condition of high “eye ball pressure”. However, besides lowering the pressure in the eye, Apraclonidine causes the Muller muscle in the upper eyelid to contract and lift the upper eyelid about 2mm.The usual dose of Apraclonidine 0.5% is 1-2 drops, 3 times per day until the Botox wears off. (Note, 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.) Apraclonidine should be used with caution in patients taking Beta-blocker eye drops (ex – Timolol), or certain pills for high blood pressure (such as Beta-blockers), Digoxin, and those taking MAO inhibitors (ex – Phenelzine) for Depression. Be sure your prescribing physician also discusses 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...A Droopy Eye-BROWA 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

The position of the brows is determined in large part by a balance between the muscles that elevate it and the muscles that pull it down. When the brow begins to drop, there is often a compensatory response by the muscles that lift it, which in turn causes the horizontal forehead lines (this is called "frontalis hyperactivity"). The temptation is to treat the lines with Botox, which will make them go away but then there is nothing holding the brow up. So it takes judgment, and often it is important to inject the brow depressors also in those instances. Your own injector should be able to evaluate and advise, and of course your situation may be different.