Help for Droopy Eyes from Botox

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!

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

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!

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.

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.

 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.

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.  


 

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

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.

Thank you for your question. I am sorry to hear about your situation and I understand your concern. Botox is a purified protein used to address wrinkles associated with facial expression. When injected into the skin Botox will relax the muscles and smoothen out the overlying wrinkles. The most common areas of treatment are in the upper face. These include the horizontal lines seen on the upper forehead when one raises the brows, the vertical lines seen between the brows when one frowns (frown lines), and the crow's feet seen around the eyes when one smiles. The appearance of frown lines is variable from person to person. Usually they are in a vertical orientation but sometimes they can be oblique and sometimes a horizontal line is seen across the upper portion of the nasal bridge. The most common variation is to have two parallel lines, hence the common term "11's" to describe them. But some people have one, three, or more lines. Some people also will see a bulge in the area when contracting the muscle. This bulge is smoothened out after a Botox treatment.The pivotal studies used 20 units of Botox in the glabella area between the brow to address the frown lines. These studies demonstrated that the peak results are seen 14 days after the treatment and most people enjoy their results for 3-4 months. At that point, a maintenance treatment is recommended. While some people start to see results as early as the next day, it can take two weeks for full results so patience is important. We have our patients return 2 weeks after their treatment to assess their results via photographs. At that time additional units may be added if necessary.With any injection, there are risks such as pain, bleeding, bruising, redness, swelling, tenderness, and infection. We take special precautions to minimize these risks such as using a painless technique. We also treat bruises with a laser as early as the next day. Bruises usually resolve within 2 weeks if untreated. After a laser treatment bruises usually resolve in 1-3 days, but may still take 2 weeks for full resolution. I recommend that my patients apply cold compresses such as ice packs and sleep on an extra pillow if not uncomfortable to reduce swelling.In addition to these risks, with Botox there is also a risk that the product spreads or diffuses to nearby structures. Most importantly are muscles required to perform various functions. The muscles that are treated with Botox around the eyes are close to the muscle that lifts the upper eyelid. If this muscle is affected it can lead to a temporary droopy eyelid (blepharoptosis). The duration depends on the placement of the product and the dose used. Usually it resolves in 2 weeks, but it can last up to 4 months. Blepharoptosis can be treated with apraclonidine 0.5% ophthalmic solution (also known as iopidine) and various other medications. For my patients, I recommend 2-3 drops to the affected eye 2-3 times per day. When the blepharoptosis begins to wear off patients notice less of a droop when waking up in the morning after the last dose of apraclonidine has worn off. The incidence of blepharoptosis is reported to be approximately 1% but in my experience, I find it to be about 0.1%. This is likely due to the fact that when these studies were initially performed injectors may have not been as aware of this adverse effect nor been taking extra precautions to avoid it.Blepharoptosis occurs when Botox is placed near the eye and it diffuses to the muscle that lifts the upper eyelid (levator palpebrae superioris). This is located inside of the orbital rim above the globe. To avoid this side effect, I place the product at least 1 cm from the orbital rim. When placing product between the brows I pinch the area to be treated and lift it so that the product is placed in the muscle and is less likely to diffuse around the bone into the orbital space. Diffusion into this area may also be caused by other preventable things. For this reason, I recommend that my patients follow the aftercare instructions below. This may be a reason for the low incidence of side effects in my practice. I encourage my patients to contact our office and return for a follow up visit with any questions or concerns.After a Botox treatment, I recommend that my patients avoid heat exposure, alcohol consumption, and strenuous exercise for 24 hours and not lie down flat for 4 hours. This is because all of these activities may possibly lead to the movement of the product and consequent side effects such as droopy eyelids as described above. Although there have been no definitive studies shown that these actually occur and some physicians do not provide such aftercare instructions, in the absence of data I err on the side of caution and recommend that my patients avoid such activities.Botox is what we call a neuromodulator. This means that it controls nerves to prevent the muscles from contracting. Botox is the most popular neuromodulator available, has been the most studied, and is cleared for the most number of indications. Other neuromodulators available in the United States include Dysport, Xeomin, and Mybloc. Overseas many others are also available. Each product has slight differences, but all of them work. The majority of our patients find that they like the results of Botox the best. Additionally, Allergan, the maker of Botox, offers the Brilliant Distinctions Program. This is a rewards program where patients receive points from their Botox treatments which can be used toward discounts at subsequent treatments. Points are also received when patients purchase other treatments in the Allergan portfolio including Juvederm Ultra, Juvederm Ultra Plus, Voluma, Volbella, Vollure, and Kybella or products such as Latisse or Skin Medica products.I find that combining Botox with other treatments or skin care regimens enhances the results and allows patients to enjoy their results for longer. One specific topical product our patients have found to be outstanding in conjunction with a Botox (and filler) treatment is our Hydrating Serum, which contains hyaluronic acid. Hyaluronic acid draws water into the skin and helps to fill in fine lines and wrinkles.Please consult with a doctor for specific recommendations. Good luck!