Eyelid Drooping, Ptosis from Botox. What Can I Do to Fix the Problem?

Aizza, I am sorry that you are having this problem, caused by inadvertent migration of Botox molecules to the eyelid elevators, or loss of tone of the brow and eyelid muscles. It will indeed wear off over time, but in the meantime, your injecting physician can prescribe one of several eyedrops that strengthen other eyelid elevator muscles and partially (hopefully near-completely) improve the eyelid droop.

Your description of the injection site near the hairline is an unusual cause for eyelid droop, and in your case may be due to the fact that your basic eyelid position is affected by your frontalis muscle tone. If you look closely at your photograph, the eye that is more "open" also has a brow that is "higher!" Perhaps a bit too much Botox in the right side has decreased your frontalis muscle tone asymmetrically, causing your right brow (and eyelid) to be positioned lower.

Thus, another (not really recommended, but one to consider if all else fails) possible trick would be to inject a bit more Botox on the left side to allow that brow and eyelid to drop as well. You might look tired or sad for a few months, but your brow and lids would match better. Then, get less Botox, regardless of location, next time!

Thank you for the picture.Before I discuss the etiology of eyelid droop after Botox and its treatment, I will say that it is highly unusual for eyelid drooping to occur if only the top third of your forehead was injected.   I would carefully evaluate the pre-injection pictures that your physician took before you received your injection.  If pictures were not taken, I would look at some of your own "close-up" pictures to carefully assess if your right eyelid isn't normally slightly lower than your left.  If, however, this is not the case and your eyelids were indeed even before you injected, read on...A droopy 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. Typically, a lower dose diffuses onto the levator muscle and so the GOOD NEWS is that the eyelid droop will typically NOT last as long as the full Botox duration of 3-4 months. However, if the eyelid droop occurs 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...Apraclonidine (Iopidine) eye-drops for Botox-induced eye-LID droop can provide a small (2mm) improvement -- Apraclonidine 0.5, 1-2 drops, 3 times per day. 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. 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...In the future, be sure to seek 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, 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.Dr Markarian

Hi aizza.  In looking at your picture, we do see that the right eyelid appears to cover more of the iris then the left.  With that said, we often see patients that have a slightly different lid elevation before they have any Botox injected.  We capture this in the "before" pictures.  Were any taken of you that you could reference back to?

While it's certainly possible that the injections you received cause eyelid ptosis, it is more difficult to envision this if your MD was injecting only the top 1/3 of the forehead near the hairline.  We suggest going back for a visit to review the "before" photos.  If it does turn out the the injections caused this, the issue should resolve itself in a matter of about 6-8 weeks.  Hope this helps and good luck.