Heavy, Droopy Eyelids and Eyebrows After Botox

I had Botox on my forehead and frown lines. Now my eyelids feel heavy and my brows have dropped with the outer ends raised. Can this be altered? Or at least, will they go back to normal until Botox wears off? How long will this last?


Doctor Answers 8

Brow ptosis (drooping) will improve as the Botox wares off

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Botox causes paralysis of the underlying muscles with the intention of decreasing the wrinkling of the overlying skin. The underlying muscles are in balance and help to maintain facial expression - including brow position. When the support of the brow height is thrown off with Botox, then the brows may drop. The answer next time, if for less Botox directly above your brows which will leave enough support to keep the brows elevated. The "heavy lids" is likely due to the dropped brows compressing the skin of the lids between the lid margin and the brow. All of this will resolve as the Botox wares off. Good luck.

Yes, and Yes

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You describe chemical denervation or ptosis of the brow. Simply put, the nerves that keep the brows up, and also cause wrinkles, were blocked by Botox. This will self correct over time. Alternatively, your doctor and you may elect to inject some Botox into the muscles that oppose the ones taken out, and hence give a little better balance to your brow.

Probably too much Botox

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You probably had too much Botox injected in the forehead. It happens occasionally, even to the best of us. The truth is that sometimes it can be difficult to predict how the same dose and location of Botox will affect different patients. The same amount could be perfect for another individual, but obviously it was too much for you. It will gradually wear off. It is also useful information for you to have for your next treatment.

I would go back to the treating physician's office and talk to them about it. Sometimes slight modifications with additional Botox can be made to the muscles that pull you eyebrows down, and this can improve the overall balance. Restylane injections can be used to get an additional slight brow lift, and overall, this can help you until the strong effect on forehead mucsles wears off.

Stella Desyatnikova, MD
Seattle Facial Plastic Surgeon

Heavy central brows after botox

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Medial brow ptosis or descent of the central brow can occur for several reasons:

  • -Botox placed too low within the frontalis muscle along the forehead including central forehead.  The frontalis muscle elevates the forehead and by decreasing activity here the central brow can drop
  • -Botox placed too superficially along the corrugator.  The botox will again impact the frontalis muscle and paradoxically lower the central brow.

Botox is best injected by an experienced injector to lessen wrinkles while improving facial appearance.

Anil R. Shah, MD
Chicago Facial Plastic Surgeon
4.8 out of 5 stars 181 reviews

Eyebrow droop after Botox

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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

Cameron Chesnut, MD, FAAD, FACMS
Spokane Dermatologic Surgeon
4.9 out of 5 stars 123 reviews

Correcting Droopy Eyelids and Eyebrows After Botox Injections

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We have learned over the years that injecting the forehead and the frown lines is not as easy as some of us thought early on. Skilled injectors who know what to do and how much toxin to inject into each area can do it; this is best done by a board-certified dermatologist or plastic surgeon.

We are in current evaluations with that indication, and soon hopefully we can actually have an FDA indication to treat the forehead and frown lines with specific recommendations on what is not enough toxin, what is too much and how much is just right.

If there is any droop, or ptosis, this needs to be corrected. If the lateral brows are raised up, theso-called Spock sign, this needs to be corrected by people who know what they are doing to correct these issues.

You might want to wait until everything wears off, but I would recommend seeing someone who is really skilled here and see what can be done to minimize these effects and to takecare of things that can be easily corrected.

Michael Gold, MD
Nashville Dermatologic Surgeon
3.9 out of 5 stars 17 reviews

You should revert back to normal after 3-4 months

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Typically, Botox lasts 3-4 Months and when it wears off, you should revert back to normal. We usually don't put much Botox in the lateral part of the brow so that you will get some lift in that area. It is usually placed in a V shape with the bottom of the V at the top of your nose.

Scott Tucker, MD
Winston Salem Plastic Surgeon
5.0 out of 5 stars 32 reviews

It will correct itself in 3 to 4 months

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It sounds like you might need a forehead lift. The botox relaxes the frontalis muscle which holds the eyebrows up. When paralized the brow descends and feels heavy in people who need a brow lift. Since the effects of botox only last 3 to 4 months, the drooping brow will correct itself after that amount of time.

Robert M. Jensen, MD
Medford Plastic Surgeon
4.8 out of 5 stars 46 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.