What can be done about a dropped eyelid after Botox?

Question

I did a Botox treatment 2 weeks ago, and after 6 days my eyelid dropped ( the left eye). This was not the first time to do Botox, But I never had eyelid drop before, could you tell what is my eye will go back to normal? And how long it will take? I am currently using eye drop from Allergen co. The injector told me that the product was made in UK

Aldo Guerra, MD · Answer

Continue to use the drops under the supervision of an eye specialist and give it time. It might resolve sooner as opposed to later if the Botox migrated down. Good luck. Dr. Aldo

Michele S. Green, MD · Answer

Botox is made by Allergan and not in the UK so I would just check which product you were injected with.  Since Botox can last from 3 to 4 months your droop may also last that long but should look better with no residual problems after all of the Botox wears off.  Best, Dr. Green

Alex Eshaghian, MD, PhD · Answer

Thank you for your question meldesso. I understand your concern. Botox is a purified protein used to address wrinkles associated with facial expression. When injected into the skin Botox will relax the muscles and smoothen out the overlying wrinkles. The most common areas of treatment are in the upper face. These include the horizontal lines seen on the upper forehead when one raises the brows, the vertical lines seen between the brows when one frowns (frown lines), and the crow's feet seen around the eyes when one smiles.It is difficult to make an assessment in the absence of consistent photographs before and after in the same lighting and angles for comparison. However, I hope the information provided here is useful.The muscles that are treated with Botox around the eyes are close to the muscle that lifts the upper eyelid. If this muscle is affected it can lead to a temporary droopy eyelid (blepharoptosis). The duration depends on the placement of the product and the dose used. Usually it resolves in 2 weeks, but it can last up to 4 months. Blepharoptosis can be treated with apraclonidine 0.5% ophthalmic solution (also known as iopidine) and various other medications. For my patients, I recommend 2-3 drops to the affected eye 2-3 times per day. When the blepharoptosis begins to wear off patients notice less of a droop when waking up in the morning after the last dose of apraclonidine has worn off. The incidence of blepharoptosis is reported to be approximately 1% but in my experience, I find it to be about 0.1%. This is likely due to the fact that when these studies were initially performed injectors may have not been as aware of this adverse effect nor been taking extra precautions to avoid it. Blepharoptosis occurs when Botox is placed near the eye and it diffuses to the muscle that lifts the upper eyelid (levator palpebrae superioris). This is located inside of the orbital rim above the globe. To avoid this side effect, I place the product at least 1 cm from the orbital rim. When placing product between the brows I pinch the area to be treated and lift it so that the product is placed in the muscle and is less likely to diffuse around the bone into the orbital space. Diffusion into this area may also be caused by other preventable things. For this reason, I recommend that my patients carefully follow the simple aftercare instructions described below. This may be a reason for the low incidence of side effects in my practice.With any injection, there are risks such as pain, bleeding, bruising, redness, swelling, tenderness, and infection. We take special precautions to minimize these risks such as using a painless technique. We also treat bruises with a laser as early as the next day. Bruises usually resolve within two weeks if untreated. After a laser treatment bruises usually resolve in 1-3 days, but may still take two weeks for full resolution. In addition to these risks, with Botox there is also a risk that the product spreads or diffuses to nearby structures. Spread to nearby muscles can lead to side effects such as the temporary appearance of droopy eyelids or a temporary asymmetric smile.After a Botox treatment, I recommend that my patients avoid heat exposure, alcohol consumption, and strenuous exercise for 24 hours and not lie down flat for four hours. This is because all of these activities may possibly lead to the movement of the product and consequent side effects such as droopy eyelids as described above. Although there have been no definitive studies shown that these actually occur and some physicians do not provide such aftercare instructions, in the absence of data I err on the side of caution and recommend that my patients avoid such activities.Please consult with a doctor for specific recommendations. Good luck!

Benjamin J. Cousins, MD · Answer

Thank you for your post. Seems some of the Botox has drifted to where it may affect the eyelid's ability to elevate. The eye drops should help as will more time. Be sure to see an experienced and Board Certified injector. Hope this helps.Sincerely,Dr. Benjamin J. Cousins MD Board Certified Plastic Surgeon, Miami/Miami Beach, FL

J. Daniel Jensen, MD · Answer

Sorry to hear that you’re having this complication&hellip; While infrequent, it is one of the more common complications from Botox. Fortunately, as mentioned above, there is an eyedrop which can be of help for reducing the amount of drooping. The eyedrop is called Iodipine and is available by prescription from your physician.  Preferably, you would discuss this with the individual who treated you. I know that I would want to know if one of my patients had this complication.  If the treating individual was not a physician, I would contact a dermatologist or plastic surgeon who is experienced with Botox injection, and stick with them! The eyedrop may not completely fix the problem, But it will probably help. Eyelid ptosis, fortunately, is a temporary problem and will eventually resolve. Good luck and best wishes! Dr. Jensen

What can be done about a dropped eyelid after Botox?

Answers (9)

Answer: Iopidine eyedrops for Ptosis

Answer: Iopidine eyedrops for Ptosis

Answer: Eyelid ptosis

Answer: Eyelid ptosis

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What can be done about a dropped eyelid after Botox?

Answers (9)

Answer: Iopidine eyedrops for Ptosis

Answer: Iopidine eyedrops for Ptosis

Answer: Eyelid ptosis

Answer: Eyelid ptosis

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Everything you need to know about Botox

Our mission is to create a world where every investment in modern beauty is Worth It.