Permanent Ptosis Following Botox? (photo)

Question

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.

Sam Naficy, MD, FACS · Answer

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.

Paul S. Nassif, MD · Answer

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.

Jonathan Kulbersh, MD · Answer

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.

Harold J. Kaplan, MD · Answer

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.

Scott C. Sattler, MD, FACS · Answer

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).

A. H. Nezami, MD · Answer

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.

Steven Wallach, MD · Answer

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

Cynthia Boxrud, MD · Answer

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

Steven F. Weiner, MD · Answer

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.

Mireille Chae, MD · Answer

I agree with the other responses here that you are likely noticing natural asymmetry that is getting more noticeable with time.  Botox is not the cause - its effects last about 3-6months.  Botox actually can help treat this asymmetry.

	(This answer is not intended nor implied to be a substitute for medical advice.  It is posted for patients’ general education only.  Always seek the advice of your physician or other qualified healthcare provider for further evaluation of your individual case.)

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