Dysport eyelid droop? (Photos)

Question

I received Dysport two weeks ago in my forehead and crows feet. My left upper eyelid skin is now drooping. My right eyelid has always been slightly more droopy than the left, which is why Im noticing this difference very clearly on the left side. Would an injection near my left lateral brown help or am I better off waiting for the effects to wear off? I cannot tell if this is an eyebrow issue or an eyelid issue.

Aldo Guerra, MD · Answer

Hi John John,This looks like an eyelid issue and not a brow issue. I'm sorry to hear about your dropped eyelid. This is a risk of Dysport/Botox that can occur even in the most experienced hands. You need to contact your injector to be examined and they can write a prescription for you. The medication most commonly recommended is, Iopidine, which is an alpha adrenergic agonist which will cause a muscle in your eyelid to contract and "lift" some of the droop.  Your droop is not too bad (I've seen worse on Realself before) and will likely resolve sooner as opposed to later. Your injector can give you a better idea of how long this will go an after the exam.  
Be sure to let your injector know or see an eye specialist. Best wishes, Dr. ALDO :)

Hardik Soni, MD · Answer

Thank you for your question. From looking at your photos I believe you have eyebrow ptosis. This can happen when too much Dysport has been injected or it is placed improperly. You can have some more Dysport injected around the brow and crow’s feet to counteract this and help lift the brows. However, this should resolve when the Dysport wears off in 3-4 months. I recommend notify your injector of this issue so this can be avoided in the future. Best of Luck!

Michael H. Gold, MD · Answer

Thanks for your question and the photo – they show an eyebrow ptosis and not a lid ptosis.  You need to realize that this can occur, although rare with experienced injectors and that over time this will improve and go away as the toxin fades away.  Eye drops can be used but they are more for lid ptosis and having more Botox can be done – but only by someone very skilled in its use.

Adam Goodwin, MBBS, FRCS(Plast) · Answer

you have a very mild example of botox ptosis. The botox has just found a way to get into your eyelid elevator in a very small dose. This will improve over time, probably the next 2-6 weeks but if you really can't stand it then iopodine eye drops will improve the look if used 4 times daily during the day until the botox on that tiny muscle wears off. Hope that helps, 
Adam Goodwin

John R. Burroughs, MD · Answer

Drooping of the brows, eyelids, and other areas of the face can occur with any of the wrinkle blockers (Xeomin, Botox, Dysport etc.).  It is temporary and should improve.  Dysport tends to spread a bit more than the other wrinkle blockers, which can be its advantage as well as disadvantage.  Too much was likely placed in the left forehead, so putting more there will cause more relaxation of the forehead frontalis muscle and therefore more drooping.  Placement at lateral crows feet and the depressor supercilaris might help, but probably best to just wait it out.  Avoid any blood thinners prior to injections, which can cause more bruising and increased spread of the wrinkle blockers.  Best regards.

Steven F. Weiner, MD · Answer

Eyebrow ptosis is related to too much Dysport injection in the forehead or improper placement. You do not have an eyelid ptosis. Sometimes injections in the brow and crows feet area can counteract this problem and lift the brows. Either way, this is a self limited problem and should go away before the complete effects of Dysport are gone.

Matthew Sniegowski, MD · Answer

Thanks for the question, based on the photos you have supplied it appears that you have developed a small amount of brow ptosis from the Dysport. The brow is elevated by the frontalis muscle in the forehead and is pulled down or depressed by the orbicularis muscle around the eye. When you receive Dysport to the forehead you weaken the frontalis muscle relative to the orbicularis muscle, this leads to the lower brow position. Ultimately you will have two options, you can give it time and Dysport will lose its effect in 4-6 months or you can ask for a small amount of toxin to be injected below the eyebrow. The injection of Dysport below the eyebrow will help to weaken the downward pull of orbicularis. The only downside of injected Dysport below the eyebrow is that ~5% of patient will develop actual eyelid ptosis from the toxin migrating into the eyelid lifting muscle.

Glenn Messina, MD · Answer

I see what you are talking about its not a full droopy lid but the forehead is no longer able to lift the brow and the sag is showing up on the lid surface. Did they do the glabellar area ( between the eyes for the "11" lines? If not have them do that as well because that will lift and separate the brow and couple that with a few units 4-5 in the lateral brow.
The next session if the did inject all 3 areas ( glabellar , frontal, crows) would be to go lighter in the forehead dosage.

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