Help for Droopy Eyes from Botox

I had Botox done on my forehead almost 2 weeks ago. 2nd day I noticed the droopy eyes, but now one eye is getting better and the other eye is getting worse. and the vision in the worse eye seems to be affected too. They want me to come in to see if they can fix it, but i'm really nervous about that. I look like I've had a stroke.

Doctor Answers 18

Droopy eyelid is very technique dependent


In the early clinical trials of Botox® done by Allergan, Inc., the incidence of drooping lid or ptosis was 3.2 percent. It was found to be very technique dependent. In other words, some practitioner’s had a much higher incidence while others had very little.

Fortunately, the effects of Botox do not last forever and often in these cases will get much better in a few weeks.

In the meantime, the ptosis (drooping lid) you are currently experiencing may be responsive to treatment with apraclonidine 0.5% eyedrops, one three times per day until the drooping is gone. These are only available with a prescription so you would need to consult a doctor. There are some contraindications (reasons you should not use the drop) such as if you had cardiovascular disease, chronic renal failure, raynaud’s disease, and others. The most come side effect is an allergic type reaction. You might experience itching, redness, and swelling of the eyelids. If this occurs, you should stop the drop. Surgery is generally not advised for a short term, Botox induced ptosis.

Portland Oculoplastic Surgeon
4.0 out of 5 stars 4 reviews

Droopy eyelids after Botox injection

Droopy eyelids after Botox injection is a very rare, but troubling side effect.  It has been demonstrated to be dependent on the injector and the technique used.  There are some rules and guidelines when injecting that can help decrease the potential of this happening, which is why you should only have Botox injected by someone with intimate familiarity with the anatomy of the skin and face.  In cases of eyelid drooping, alphagan or lodipine drops can be effective in helping treat the droopy eye until the eyelid muscles start working better in a few (4-8) weeks.  Vision changes are unlikely to be caused by Botox.  I would be evaluated by your doctor to determine what potential treatments are available.

Good luck!

P. Daniel Ward, MD
Salt Lake City Facial Plastic Surgeon
5.0 out of 5 stars 42 reviews

Treatment of droopy eyelid after botox

When a droopy eyelid occurs after a Botox treatment, there is treatment for it. Apraclonidine 0.5% drops, neosynephrine hydrochloride 2.5% or brimonidine 0.1% can be used. Additionally, the great thing about Botox is that after 3 months it just wears off. Sincerely, Martin Jugenburg, MD

Martin Jugenburg, MD
Toronto Plastic Surgeon
4.9 out of 5 stars 469 reviews

Botox and droopy eyelids

Botox can sometimes cause a droopy eyelid. This resolves with time but in the meantime an eyedrop (iopodine) can be used to lift the eyelid. The droopy will get better over the next couple weeks. I would have an ophthalmologist check your vision because botox does not affect the optic nerve. Occasionally patients can get double vision which can create a small blur when both eyes are open. Also the droopy eyelid can cause small changes in the need for glasses and create astigmatism. The important thing is that this is all reversible.

Chris Thiagarajah, MD
Denver Oculoplastic Surgeon
4.9 out of 5 stars 9 reviews

Prescription eyedrops will help til droopiness goes away

Botox or Dysport injections to the frown lines can cause droopiness of the upper eyelid. This is very rare in experienced injectors (I've been doing it for 20 years, my physician assistant - P.A. - for 10 years). The risk of eyelid drooping may be increased with the use of Dysport instead of Botox, as Dysport is reported to spread more.

Eyelid drooping occurs when the medicine goes into the muscles that are responsible for opening the eye (orbicularis oculi), instead of the frown muscles (corrugator and procerus muscles).

Temporary treatment is available in the form of a prescription eyedrop that will stimulate the muscle and raise the lid. Normally, the eyelid droopiness resolves in 2-3 weeks, so hopefully you're almost fully recovered. The recovery time will depend, though, on how much Botox actually migrated into that muscle.

If you are uncomfortable going back to your doctor or want a second opinion, you can see an oculoplastic surgeon ( to find one near you).

Jonathan Hoenig, MD
Beverly Hills Oculoplastic Surgeon
5.0 out of 5 stars 40 reviews

Botox droopy eyelids

Eyelid 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 truly a droopy eyelid. Droopy eyebrows are much more common and result from immobilizing the only muscle on the forehead that is able to lift up our eyebrows. 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 105 reviews

Botox Help

I’m sorry to hear about your unpleasant experience after your Botox injections. Botox is an extremely effective product, but if too much is used (especially around the eyes) it can cause heaviness or drooping like you have described. It takes about 2 weeks for Botox to take full effect, so you wouldn’t want to alter anything before then. Since you are right around the 2 week point, I would recommend scheduling a follow up appointment with your injecting physician. Your nervousness is understandable, but it’s likely that they can do a touch up to help raise the muscles that have become droopy. Good luck!

Babak Azizzadeh, MD
Beverly Hills Facial Plastic Surgeon
4.1 out of 5 stars 9 reviews

Droopy eyes after Botox

Thank you for your question. Sorry to hear about the droopy eyes. It sounds like you are experiencing ptosis. It is something that can be partially corrected with the use of eye drops. Your physician would need to prescribe it. It will also wear off as the effect of Botox wears off.

Young R. Cho, MD, PhD
Houston Plastic Surgeon
4.8 out of 5 stars 37 reviews

Droop Eyelid from Botox...

Eyelid droop is a rare, but known, side-effect of Botox. 

The good news is that this is NOT permanent, and you do have some options in treatment...

A droopy eye-LID due to Botox can be treated with Apraclonidine eye-drops which 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.

Droopy eyes and vision problems are possible but temporary with Botox

Unfortunately, though Botox seems very simple to do, it is actually highly dependent on the experience and technique of the injector, as well as an understanding not only of facial surgical anatomy, but also that everyone's anatomy is individual and can vary from person to person. Not every muscle or nerve is in the same place in every face. For this reason, there are sometimes risks of (luckily temporary) problems with Botox going where it should not go, or being put where it should not be put. There are special eye drops which can help to clear vision and get the lid lifted a bit during the period the Botox needs to wear off naturally. Unfortunately this just takes time and there is no quick way to "undo" the Botox. Follow up with your physician or see a "core four" cosmetic physician injector to help get you through this frustrating period.

Jessica J. Krant, MD, MPH
New York Dermatologic Surgeon
4.7 out of 5 stars 41 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.