Uneven eyelids after Botox? (Photo)

Question

This is the third time that I’ve gotten Botox in my eyelids for a facial tic though this is the first time I’ve had this type of reaction post Botox injections. It’s been a couple days since injections and I’m not sure if I should go call the doctor or not about this. These results have made me very self-conscious.

Deborah Kessler Hudak, MD, MHA · Answer

Yes, you should let your doctor know.  The most common cause is that the Botox amount injected was a little too much for you.  There is no antidote for the Botox....so you have to wait for it to wear off.  But it is important for your doctor to know, since she/he may desire to decrease the amount to that lid next time.

Onir Spiegel, DDS, PhD · Answer

Uneven eye brows can happen after botulinum injections as the muscles relax. It usually takes a full two weeks to see  your results, especially after the first time of injections and more so with Botox than Xeomin that kicks in a bit faster. If you find that your eye brows are still uneven, do not be concerned that can be easily corrected. Go back to your doctor and ask for an adjustment. Most doctors will not ask you for an additional fee for that. All the best from Boston, Dr. Onir

Alex Eshaghian, MD, PhD · Answer

Thank you for your question and for sharing your photograph eeoc. 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.
It is difficult to make an assessment in the absence of consistent photographs before and after in the same lighting and angles for comparison. However, I hope the information provided here is useful.The safety record of Botox is well established. The product has been used for over 20 years for a variety of treatments with minimal side effects. Botox is amongst the safest treatments for treating facial wrinkles.
  
While Botox is one of the safest treatments offered, there are some situations where it is not appropriate. These include anyone who has an allergy to any of the inactive ingredients or who has had an allergic reaction to any botulinum product including Botox, Dysport, Xeomin, or Myobloc. The safety and efficacy of Botox has not been established in women who are pregnant, trying to become pregnant, or breast feeding. Therefore, women in these categories are advised to wait until breast feeding is completed prior to having a Botox treatment. Botox should not be placed in the skin on the site of an infection. Those who are taking an aminoglycoside antibiotic, an anesthetic, D-penicillamine, antimalarials, or immunosuppressants should not be treated, nor should those who have undergone chemotherapy within the previous six months. It is important to avoid blood thinners before and after a treatment. These include both prescription and non-prescription medications such as warfarin (coumadin), aspirin, ibuprofen, alcohol, fish oil, vitamin E, and ginko biloba. Those with conditions that affect muscles and nerves such as amyotrophic lateral sclerosis (ALS or Lou Gehrig's disease), myasthenia gravis, or Lambert-Eaton syndrome should not undergo Botox treatments.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 carefully follow the simple aftercare instructions described below. This may be a reason for the low incidence of side effects in my practice.
If I had a patient with the concern described here I would say she would be a good candidate for correction of blepharoptosis as described above.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 two weeks if untreated. After a laser treatment bruises usually resolve in 1-3 days, but may still take two weeks for full resolution. In addition to these risks, with Botox there is also a risk that the product spreads or diffuses to nearby structures. Spread to nearby muscles can lead to side effects such as the temporary appearance of droopy eyelids or a temporary asymmetric smile.
  
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 four 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. 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.
  
Please consult with a doctor for specific recommendations. Good luck!

Anna Widmyer, MD · Answer

Good morning, thank you for your question.  If botox is injected into or migrates too deep around the eye it can affect the muscles that elevate your eyelid.  Typically this resolves in 2-3 weeks, but in the meantime and alpha adrenergic agonist eye drop such as apraclonidine may be prescribed which will improve the appearance of the eyelid.

Adam E. Singleton, MD · Answer

Hello - without seeing what your eyelids looked like without botox, it is difficult to make an accurate diagnosis, but it does appear there is a difference between the two eyelid positions. If there is every any concern with results from Botox, I would always contact your injector to be seen and evaluated in person. 
Best - Dr. Singleton

Emil Shakov, MD · Answer

Ptosis is a drooping or falling of the upper eyelid. It appears this may be the process in the left eyelid, but it would need to be compared with your pre-procedure pictures to confirm it. The good thing is it is temporary and usually resolves prior to the Botox wearing off in 3 months.  See your doctor and a prescription for 0.5% apraclonidine eye drops can be prescribed at a dosage of 1 to 2 drops three times a day

Rita Rakus, MBBS - Account Suspended · Answer

Thanks for sharing your experience, an unwanted side effect can be eyebrow change with botox however waiting 2 weeks for treatment to settle is the best course of action. at 14 days i would seek the advice of your injector for further management

Uneven eyelids after Botox? (Photo)

Answers (7)

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