Help for Droopy Eyes from Botox

Question

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.

P. Daniel Ward, MD · Answer

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!

Cameron Chesnut, MD, FAAD, FACMS · Answer

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

Babak Azizzadeh, MD, FACS · Answer

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!

Young R. Cho, MD, PhD · Answer

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.

Mark K. Markarian, MD, MSPH, FACS · Answer

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.

Richard J. Bruneteau, MD · Answer

It's not unusual for patients with
transverse forehead wrinkles and vertical frown lines to undergo treatment with
botox. Unfortunately, the botox can sometimes migrate and effect the
surrounding structures. When botox migrates in an inferior direction, the
elevators of the eyelid can be effected which causes the eyelids to droop. This
occurs in about 1 to 3% of patients undergoing botox injections and appears to
be related to the technical skill of the injector.

In someone who has
developed eyelid droop and looks like they've had a stroke, paralysis of the
eyelid elevator is the most likely cause. In most cases, this problem will
spontaneously resolve in 4 to 8 weeks, but variations occur depending on the
amount of botox given and the strength of the underlying muscle.

When patients are
unwilling to wait for spontaneous resolution, several options are available.
These include eye drops, which partially reverse the impact of botox. These
include the eye drops alphagen and lopidine. Both are associated with excellent
clinical responses and high levels of patient satisfaction.

If you've developed eyelid sag following botox, it's important to consult
your plastic surgeon. With these eye drops, this problem can usually be
satisfactorily addressed.

William Portuese, MD · Answer

It is critically important to make sure the injector places the Botox in the correct anatomical position the muscles of expression that are hyper-dynamic . On  rare occasions Botox effect will migrate to the incorrect muscle group. When this occurs, there are some prescription eyedrops they can help raise the eyelid to help negate the droopiness from the Botox effect. The good news is that the droopiness of the eyelid is only temporary and will return in approximately 2-3 months

Sanusi Umar, MD · Answer

Droopy eyes from Botox is a relatively common occurrence.  And it is also temporary. Usually if the droopiness has occurred within 3-4 days after your treatment,  it is likely to take about 3 or 4 weeks to dissipate. A more immediate option can include eyedrops such as alphagan or lodipine can stimulate the muscles that keep the eyes open.

	Botox should not have an effect on vision. You may want to see a different specialist for this.

Martin Jugenburg, MD · Answer

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

Ron Shelton, MD · Answer

droops can occur, even if rarely, to the most experienced injector of Botox. Your doctor probably knows of a way to help you. See your doctor and if you are still uneasy to proceed with their recommendation, then get a second opinion.

Help for Droopy Eyes from Botox

Answers (19)

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