Eyebrow Droop?

I had botox 4 days ago to the 11s and forehead . I think my eyes look heavy with eyelids sagging a little. I have very little movement in the top of my forehead but I can still move my eyebrows up and down. Does this sound like eyebrow droop and if so will it get worse? Will the botox continue to freeze my face more and make it worse? Is there anything I can do and how long will it last? It was my first go. Will moving the eyebrows up and down a lot help it? Help.

Doctor Answers 7

Eyebrow droop after Botox

It is difficult to answer your question without examining you or pre- and post-injection pictures.

However, you are either experiencing eye-LID droop or eye-BROW droop, and from your description, you likely have eye-BROW drop. I would return to your injecting physician for a complete exam to determine which of the two you have, because eye-LID droop may be treated with certain eye-drops and typically does not last as long as eye-BROW droop...

Note, the full effect of either lid or brow droop won't be evident until about 7-10 days when the full dose of Botox sets in...

Eye-LID droop can happen if the Botox was 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. This typically lasts 1-2 months but can last as long as the full dose of Botox (3-4 months). It can be treated with Apraclonidine eye drops that may raise your eyelid up to 2mm. 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...

Eye-BROW droop can happen and may appear like bunching of the upper eyelid mimicing eyelid droop sometimes; this happens from the Botox being injected too low on the brow or the patient receiving too much Botox. Too high an effective dose to the brow is commonly due to the naturally weakened forehead muscles with age (that require less Botox to be paralyzed) or overlapping treatments of Botox (i.e. getting Botox treatments too frequently resulting in overlapping effects). Note: Apraclonidine eye-drops are unlikely to help with eye-BROW droop.

Good news is, whether it's brow or lid droop, it WILL get better.

In the future, I would encourage you to seek the services of an experienced physician injector. I think the key 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.

Eyebrow Ptosis or Eyelid Ptosis?

   I read all of your posts and you appear to have eyebrow ptosis.  I am not sure if you also had eyelid ptosis as well from reading the other posts.  The eyebrow ptosis can be corrected somewhat with additional Botox into the orbicularis oculi muscle.  If you have lid ptosis, there are some medications to help until the Botox wears off.

Kenneth B. Hughes, MD
Los Angeles Plastic Surgeon
4.9 out of 5 stars 496 reviews

Botox and eyebrows

Botox can occasionally cause an eyebrow droop. Best to wait a full 2 weeks to let the Botox work, but if you are having persistent lowered brow, see your physician who can sometimes correct it for you quite easily. Worst case scenario, it can last 2-4 months; let your physician know that this happened the next time you get a treatment as there are ways to avoid this in the future.

Benjamin Barankin, MD, FRCPC
Toronto Dermatologic Surgeon
4.8 out of 5 stars 53 reviews

Botox and heavy eyelids

It takes about ten days to see the full result of your Botox treatment.  If you are not pleased with the results, you should return to your doctor for re-assessment.  He may be able to adjust your treatment or you may need to wait a few months until the undesired Botox effect wears off.  In any event, you should return to your physician so he can see the result and perhaps modify your treatment next time. 

Martie Gidon, MD, FRCPC
Toronto Dermatologist
5.0 out of 5 stars 22 reviews

4 days after Botox

At four days, the Botox may or may not be working. Sounds like from your description that it is starting. It usually takes a week and lasts for about 4 months. Hard to say if you will get brow ptosis without an exam at two weeks.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 29 reviews

Botox and eyelid or brow droop

Without knowing number of units injected and specific location, or viewing photo's of what you are referring to, it is very difficult to answer this question. You should consider at least posting photo's for better assessment of your current situation.

Sam Naficy, MD, FACS
Seattle Facial Plastic Surgeon
4.7 out of 5 stars 221 reviews

Botox and forehead movement

Not knowing your age or having a picture I will need to make some assumptions.  It sounds as if you had adequate amount of Botox to relax the glabellar/midbrow muscles which create the '11s' and enough in the central foerhead to smooth it.  The more lateral forehead muscle appears to be active still and often becomes overly active to accomodate for loss of motion of the central forehead.  We call this recruitment.  Lateral forehead can also be treated but you need to make sure the lateral brow will not come down and give you a 'hooded' appearance.  Sometimes it is better to live with some lateral upward motion instead. 

Steven Swengel, MD
Los Gatos Dermatologic Surgeon
5.0 out of 5 stars 11 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.