Botox eyelid ptosis gets better and then worse again?

Question

2.5 months ago i had botox for browlift. four units in each side (weird he did a single injection on top of my brow without my squinting) , makes me think it is all concentrated in one point. A week later i had ptosis on both sides. Anyway the botox ptosis seems to get better one day then worse the next (for the last two months) or it fluctuates on the same day. What does it mean?

Nelson Castillo, MD · Answer

Thank you for sharing your question and I am sorry to hear of your eyelid ptosis issues.  As your facial muscles move they expend enough energy that they may tire as the day progresses, worsening your eyelid sagging.  In the morning after a night’s rest they should be strong enough to again elevate your lids higher.  Once the Botox full wears off you should return to your former nappearace and no longer suffer these fluctuations. Hope this helps.

Tim Sayed, MD, MBA, FACS · Answer

Botox takes about 3 months to wear off in the average patient. Trying to create a "brow lift" with Botox is a challenging request - the injector needs to really understand the anatomy of the frontalis, corrugator, lateral brow depressors, eyelid elevators and other muscle groups. Usually if we are trying to "lift" the brow what we really are trying to accomplish is selectively leaving the lateral brow elevators (frontalis) intact and/or knocking out the lateral brow depressor muscle, which could explain a single shot to the outer brow just under the hairline of the eyebrow on each side. You need to give time for the ptosis to go away as there really is no great antidote, although some drops can be prescribed to try to overactivate one of the eyelid muscles to overcome the weakness of the levator palpebrae superioris muscle that probably got knocked out by absorbing some of the Botox.

Ram Chandra, MD · Answer

It should get better soon with Botox wearing off, at the most within another month. If ptosis persists or does not improve beyond 4 months or so, its unlikely that Botox is the cause. There could be another neurological or muscular cause, hitherto undiagnosed in which case please see your primary physician for evaluation.

Alexander M. Sailon, MD · Answer

The wavering amount of eyelid ptosis you have is likely related to muscle fatigue. This reflects that the muscles responsible for lifting your eyelids are still somewhat under the effect of the Botox. With time, this will continue to improve. Speak to your surgeon about the possibility of prescription eye drops to help with the lid position if it is bothering you. Best of luck!

Leonard Grossman, MD · Answer

First first of all, Botox is not injected into the forehead for a brow lift effect. Secondly, the reason why you feel that your eyelid ptosis fluctuates is most likely related to how tired the muscles of the upper eyelids are. As the day progresses you become more tired and the ptosis is more visible. It should get better with time. Good luck from New York City

Botox eyelid ptosis gets better and then worse again?

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Answer: Eyelid ptosis

Answer: Eyelid ptosis

Answer: Botox trouble

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Botox eyelid ptosis gets better and then worse again?

Answers (5)

Answer: Eyelid ptosis

Answer: Eyelid ptosis

Answer: Botox trouble

Answer: Botox trouble

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Everything you need to know about Botox

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