My doctor says drooping eyelid 4 days after Botox is not due to Botox leaking into muscle. What do you think? (Photo)

Question

Eyelid drooping began 4 days after having botox for the first time (to II lines and around eyes but not to horizontal forehead lines) and became progressively worse over the next 2 days, at which time the eyebrow raised on that side only. My doctor says my muscles are moving symmetrically, indicating that the drooping is not due to botox leaking into a muscle but rather to the trauma of the needle. Does this make sense? How long will it take to resolve? Will eye drops help?

Stephen Prendiville, MD · Answer

Unless you had a ptosis prior to injection, which your Physician would most likely have pointed out, this ptosis is probably related to the Botox treatment. This finding is usually short lived and can be counteracted on a short term basis by use of Iopidine drops.

David Yew, MD · Answer

I would return to the doctor and have him review the before photos to do a comparison.   From the photo - it looks markedly assymmetric.   Botox can cause a ptosis if placed in the wrong area and that will take 3-4 months for it to resolve.  Iopidine eye drops can help with the appearance but the reassuring fact is that this is temporary.   If the doctor did not take before photos - then that is his fault. You know your face best and if you are not satisfied with the treatment - you should let him know and see how he responds.   In our practice - we would issue you a refund.   No questions asked.

Nelson Castillo, MD · Answer

Thank you for sharing your question and photograph.  Unfortunately I do think your current result is due to the Botox which will need to completely wear off before your appearance and eye function will be restored.  The droop can be mitigated somewhat with the use of prescription eye drops so you may wish to discuss this with your injector.

Michael A. Zadeh, MD, FACS · Answer

I don't know the details of your injection (dose, placement, etc.), However, this is most likely due to the Botox. Things will go back to normal once the Botox wears off in 2-4 months. Eyedrops may help temporary, but they don't always work. Make sure you find an experienced injector next time. Best wishes.

Olga Bachilo, MD, FACS · Answer

I'm sorry to hear you had an adverse event with your Botox treatment. Unfortunately, sometimes you get an adverse event happen even when your doctor does everything right and you follow perfect post procedure instructions.` It may just be bad luck. A much smaller dose of Botox will effect the small muscle that raises your eyelid, and therefore will be effected earlier. Your other muscles probably have not yet responded to the Botox 4 days post treatment. The good news is, that this is temporary and will resolve after a few weeks. Using specially prescribed drops will help to resolve this problem faster. 
I wish you speedy recovery and I hope I addressed your question.
Sincerely,
Olga Bachilo, MD

Shaun Patel, MD · Answer

Unfortunately, I do believe the eyelid ptosis is related to your recent Botox treatment. Although eyelid ptosis (droopiness) is much less common then eyebrow ptosis after Botox treatment, it does happen. Unfortunately, you will need to wait for the Botox to wear off before your eyelids return to their normal position. A prescription eyedrop may help. The Botox can diffuse (spread) into the eyelid raising muscle if it is placed too close to the eyebrow.

Benjamin J. Cousins, MD · Answer

Thank you for your post. If your Dysport/Botox/neurotoxin is injected too close to the wrong portions of the peri-ocular musculature, or if you have a low brow to start with it, unwanted side effects can happen after your injections begin to kick in after about 4-7 days. The Botox can drift into unintended areas and cause "eye droop" or eyebrow drop. Still it is best to follow up with your injector and discuss your concerns as you may have to wait it out or be given a Rx for eyedrops which can help reverse the adverse effects. Always see an experienced, Board Certified injector for the best results.Sincerely,Dr. Benjamin J. Cousins MDBoard Certified Plastic Surgeon

Melvin Elson, MD · Answer

If you did not have drooping prior to the Botox injection and you do have it after then it is most likely due to the Botox injection.  Iopidine eye drops will help elevate the lid and be sure you are seeing a board certified dermatologist

Aurora DeJuliis, MD · Answer

I am sorry you are having some unwanted problems with your first botox experience. Botox usually start to take effect three days after injection and will pick in two to three weeks. It is my personal opinion, but I feel your are experiencing eye lid drooping secondary to Botox. The good news is the unwanted results will dissipate in few weeks.
Thanks.

Alex Eshaghian, MD, PhD · Answer

Thank you for your question and for sharing your
photograph csg8525. I am sorry to hear about your situation and 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 appearance of frown lines is variable from
person to person. Usually they are in a vertical orientation but sometimes they
can be oblique and sometimes a horizontal line is seen across the upper portion
of the nasal bridge. The most common variation is to have two parallel lines,
hence the common term "11's" to describe them. But some people have
one, three, or more lines. Some people also will see a bulge in the area when
contracting the muscle. This bulge is smoothened out after a Botox treatment. The pivotal studies used 20 units of Botox in
the glabella area between the brow to address the frown lines. These studies
demonstrated that the peak results are seen 14 days after the treatment and
most people enjoy their results for 3-4 months. At that point, a maintenance
treatment is recommended. While some people start to see results as early as
the next day, it can take two weeks for full results so patience is
important. We have our patients return two weeks after their treatment to
assess their results via photographs. At that time additional units may be
added if necessary.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.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.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 as described above. 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!

My doctor says drooping eyelid 4 days after Botox is not due to Botox leaking into muscle. What do you think? (Photo)

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