Permanent Ptosis Following Botox? (photo)

I had botox on my forhead 4 times in my life in the last 2 years, the last time being in Aug 2012. In the last year I noticed one eyebrow is lower than the other. I looked at pictures of myself from 10 years ago, 2 and 3 years ago and I did not have this before. If I use my muscle to raise the eyebrow then it evens out but otherwise they are definitely uneven. Did botox give me permanent ptosis or is this something more serious and unrelated? The 2nd pic is of me raising the lowered brow.

Doctor Answers 13

Bo-tox and Ptosis

Dr. Steinsapir, the lead author, Michael Groth and I did a paper looking at ptosis following injections of Bo-tox.   We reviewed seven cases and it was presented to the ASOPRS conference.   Be cautious about having the droopy eyelid operated on as we and I had a case of a patient who it took about 12 months to recover.  The second important point was that with injections to the deep brow in patients who have relatively thin skin...this can be a problem.

Hopefully, for you all will resolve well.


Dr. Cynthia Boxrud 


Santa Monica Oculoplastic Surgeon
5.0 out of 5 stars 6 reviews

Botox and permanent damage

Botox is temporary and doesn't cause ptosis of the muscles. It's injected into the musculature and is intended to relax the area for 3-4 months. It's possible you are just noticing things you hadn't in the past. As you know, we all experience a multitude of changes to our faces and bodies, with every passing day.

Sam Naficy, MD, FACS
Seattle Facial Plastic Surgeon
4.7 out of 5 stars 221 reviews

Permanent ptosis following Botox?

Botox will not cause permanent ptosis because the Botox itself is temporary. There may be another issue causing your ptosis, and an exam with a specialist would be necessary to determine whether there is another condition causing your issue. I hope this helps, and I wish you the best of luck.

Paul S. Nassif, MD
Beverly Hills Facial Plastic Surgeon
4.7 out of 5 stars 47 reviews

Permanent ptosis following Botox?

Botox is temporary. Because of this, any associated side effects are temporary as well. In general, the side effects of Botox may include the following:

1) Light bruising
2) Swelling
3) Temporary ptosis

I would recommend speaking with a board certified oculoplastic surgeon if you are concerned about ptosis. There may be another issue that needs attention. I hope this helps, and good luck.

Jonathan Kulbersh, MD
Charlotte Facial Plastic Surgeon
5.0 out of 5 stars 66 reviews

Botox and Permanent Ptosis

The effects of Botox are not permanent and therefore cannot cause permanent ptosis. It seems that your Botox injection was 7 months ago,there should be no effects of Botox remaining by now. If you have an asymmetry or ptosis of your eyebrows or eyelids, It should be preexisting. If you believe it was not preexisting and is a recent occurrence, then you should consult a neurologist. 

A. H. Nezami, MD
Jacksonville Plastic Surgeon
4.8 out of 5 stars 32 reviews

Botox and permanent brow ptosis

Botox does not cause permanent brow ptosis. Give it time to wear off, it will likely improve with time.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 29 reviews

Permanent Ptosis?

Hi Anon.  Botox does not cause permanent ptosis because the effects of Botox are not permanent.  It does appear that you have some heaviness in the left lid, but if this area looks like this all the time, it is just part of who you are.  Botox can make it better or worse, but it cannot permanently change your look.  

If the condition came on suddently, then you may want to check with a neurologist.  Otherwise, we would actually suggest using a Botox browlift to help with the issue.  

Harold J. Kaplan, MD
Los Angeles Facial Plastic Surgeon
4.3 out of 5 stars 6 reviews

Brow asymmetry often represents natural variation is not Botox related

My guess is that you have natural asymmetry of your brow position. As you age, this may become more obvious. For patients with any hint of brow ptosis, I tpically treat the 'brow depressor' muscles with Botox (glabella and lateral orbicularis muscles) and leave the frontalis muscles alone (brow elevators). 

Scott C. Sattler, MD, FACS
Seattle Plastic Surgeon
4.8 out of 5 stars 65 reviews

Brow asymmetry 1 year after Botox is not related.

The effects of Botox will last about 3-6 months.  When the effect has worn off, you go back to your natural state.  Most people are not symmetric and as we age, these asymmetries usually become more apparent.  Sometimes you can use Botox to help the differences in brow position to make them more even.

Steven F. Weiner, MD
Panama City Facial Plastic Surgeon
4.7 out of 5 stars 41 reviews

Eyebrow position after ptosis

What happens to our bodies is that they continue to age even while we get procedures like Botox or fillers done. It does slow up the aging process to do these types of procedures, but what you are noticing is a natural asymmetry that's occurring. As bodies age, facial shape changes. In general, when people are young, they have a facial shape like an inverted triangle - tight jaw, pointed chin, open and wide eyes, etc. As we age, that shape inverts and gravity brings everything down - natural ptosis sets in, eyebrows fall a bit, the cheeks fall, and the jowls and jawline become more square. Since you haven't been seeing this happen because you've been preventing more drastic changes with a procedure like Botox, it now seems very dramatic. But the Botox didn't cause ptosis, natural aging did.

F. Victor Rueckl, MD
Las Vegas Dermatologist
4.6 out of 5 stars 17 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.