Eyebrow Droop After Botox?

Thanks for asking about Botox and your results.  Here are some tips to head you in the right direction:

1.  don't panic, it will wear off gradually

2.  return to your doctor so that she may see your result, quantify the amount of units used, note it in your record and take this into account at your next treatment. 

3.  your doctor will be able to determine if any additional touch up or ancillary treatment will improve the situation

4.  often times it is not the eyelid that is actually drooping. Rather it is the relaxation of the forehead muscle that leads to the eyebrow shifting downward. This small shift can be enough to crowd the upper eyelid skin and give the appearance of a lower seated eyelid.  It's important for your doctor to make this distinction which is why a follow up visit may give you some assurance.

3.  everyone's face is asymmetric and successful Botox treatment requires an understanding of the facial anatomy, the subtle difference from one side to another and an adjustment of injections accordingly.

Thanks for asking!  Ellen Mahony, MD

Patients who have concerns about their treatment should see the provider that performed the treatment to analyze the effect of the Botox and see if their is more of a forehead lowering pushing down the eyelid, or an actual upper eyelid droop from temporary weakening of the levator muscle. The peak effect of Botox is between a week and two and should not look any worse after this time. Any weakening should be fully resolved by four months, and usually it looks close to normal by 12 weeks.If the doctor diagnoses a levator weakening, there can be improvement by a couple of mm. of elevation by using a prescription eyedrop. If the forehead muscle is weakened in areas very low near the eyebrow, by Botox placement there, the doctor may see how much activity is still present in the muscles that normally pull down on the forehead and if these muscles haven't completely been relaxed then more units in those muscles will help the forehead elevate more and, in turn, pull up on the eyelid.

Eyebrow drooping after neuromodulators like Botox, Dysport or Xeomin is a rare but well described issue, usually resulting from product placement or the amount used. 
The first thing that needs to be determined is whether it is a droopy eyebrow or a droopy eyelid. Droopy eyebrows are much more common and result from over-immobilizing the only muscle on the forehead that is able to lift up our eyebrows - choosing the right amount and placement in the right patient is key to good forehead results. Droopy eyelids come from the product getting into the wrong muscle that elevates the eyelid. 
Management of them is quite different, but both have strategies to help expedite resolution while waiting for them to resolve with time, and any experience injector should be very familiar with how to deal with them: drops for the eyelids and precise placement of Botox in the brow depressors when it is an eyebrow issue. 
To ensure you are receiving the highest level of care, seek out a modernly trained, new-school dermatologic surgeon, oculoplastic surgeon, facial plastic surgeon or plastic surgeon who is board certified and fellowship trained in one of these "core four" cosmetic specialties. Membership in organizations like the American Academy of Facial Plastic and Reconstructive Surgery help to identify a highly trained surgeon.
Cameron Chesnut#realself500 Physician