Does getting Botox in horizontal forehead lines increase chances of droopy eye? (Photo)

I went to my dermatologist for my annual skin check. I had discussed with him last year about possibly getting Botox. I asked for it and he said that "he didn't have a good feeling about my face" and that I'd have a higher chance of ending up with a droopy eye. He said I'd need a eyelid lift before Botox. My girlfriend recommended seeing a plastic surgeon instead of a derm. I am 37 and have friends with great Botox results. Was he right? Or should I see a surgeon to do injections? Thank you.

Doctor Answers 15

Does getting Botox in horizontal forehead lines increase chances of droopy eye?

You can benefit from Botox without having brow ptosis.
Kenneth Hughes, MD
Beverly Hills, CA......................

Botox for forehead lines

No, however it may cause droopy eyebrows. 10-5 units of Botox should be enough to soften the horizontal lines. It is important to see a doctor that specializes in these procedures to ensure that it is done properly, which will give less room for issues to occur.

David A. F. Ellis, MD
Toronto Facial Plastic Surgeon
4.0 out of 5 stars 7 reviews

Botox injections

Thank you for your question merdar. When receiving cosmetic treatments such as Botox I recommend you consult with someone with experience. There are board certified doctors with experience doing Botox treatments and board certified doctors without experience. Some non-board certified doctors, non-core doctors (for example Family Medicine), nurse practitioners, physicians assistants, and nurses have a tremendous amount of experience with injectables. Experienced injectors have a lower incidence of side effects with such treatments. There is not question that with an experienced injector people get great results.
In the pivotal studies with Botox used to treat frown lines, 3% of subjects complained of droopy eyelids. In my experience it has been less than 0.5%.
When treating horizontal lines across the forehead seen when you raise your eyebrows, it is important to inject at the correct sites. Some people with broad foreheads have horizontal lines from the upper to lower portion of the forehead. If the lower lines are treated the brow may feel heavy. If they are not, they may still have lines in the lower area. I recommend speaking with your doctor for specific recommendations. Good luck!

Alex Eshaghian, MD, PhD
Encino Physician
5.0 out of 5 stars 1 review

Botox and droopy eyelids/eyebrows

The pictures are limited and so I would defer to your doctors in-person consultation. With that in mind, it looks, based on the photos, that you are somewhat dependent on your frontalis muscle to keep your eyebrows  raised. In a situation like this, Botox to the forehead can result in brow ptosis. However, low dose (4-6 units) injections, higher up on the forehead are usually safe. Botox can also be injected in the brow depressor muscles to help open up your eyes and raise your brows.

Botox and Droopy Eye

Thanks for your question!
Injecting Botox into the forehead can drop your eyebrow position, but is less likely to give you a droopy eye.  If you already have a lower eyebrow position, Botox can be strategically injected into certain other muscles to help raise your brows. 
I would suggest a consultation with a board certified injector to help answer any and all of your concerns.
Best of luck to you!

Botox does increase your chance of a droopy eyelid

 you raise a number of issues.

firstly if you inject Botox above the eyebrows, it definitely increases your chance of a getting a droopy eyelid. it is very safe to inject it in the central forehead.

if you have droopy eyelids already, an upper lid blepharoplasty should definitely be done by a Plastic Surgeon only. i do these in my office with local anesthetic and some oral sedation, in one hour and your can return to work in 48 hours.

if your derm is not comfortable doing your Botox then definitely see someone who is comfortable doing it.
being a PS, i would suggest a PS but there are many derms who also do a lot of Botox with excellent with excellent results.


david berman md

David E. Berman, MD
Sterling Plastic Surgeon
4.9 out of 5 stars 82 reviews

Droopy Eye and Botox

Yes, the chances are higher if you already have a heavy brow or ptotic brow. If you have to elevate your brow to keep your upper eyelids from obstructing your vision, then Botox is not a good idea. 

Millicent Odunze-Geers, MD, MPH
Sacramento Physician
4.6 out of 5 stars 5 reviews

Does getting Botox in horizontal forehead lines increase chances of droopy eye

Injecting your horizontal lines of the forehead with Botox would not make the eyelid droop, but it will make your eyebrows droop. That can make you appear to be tired and have less area to apply your upper lid make up.

Julio Garcia, MD
Las Vegas Plastic Surgeon
4.8 out of 5 stars 26 reviews

Botox and Droopy Eyelids

There are various ways that and eyelid can be droopy.  To explain that all would be more information than most people would want to read.  However let me narrow the answer down to what I suspect your doctor was concerned about in your case.  One disclaimer, because your photos are shot from above, it is not possible to see your eyelid position accurately.  Generally photos straight ahead are the most helpful.

When people have low eyebrows and/or extra skin on their lids, they tend to raise their brows, subconsciously, in order to see better.  Raising your brows often causes horizontal forehead lines.

Botox treats these forehead lines by temporarily relaxing the muscle that raises the brows.  However it also can temporarily reduce your ability to compensate for the droopy eyelid.  That can cause the lid to appear droopy after botox.

The key is to see an experienced doctor who specializes in Botox.  That way you can learn if Botox is a good idea for you and the treatment can be tailored to take into account your low eyebrows or heavy lids.

Hope this is helpful.

Marc Cohen, MD
Philadelphia Oculoplastic Surgeon
4.8 out of 5 stars 23 reviews

Osbotox and eye droop

it is possible to get eye droop from injection of Botox anywhere above the eyes, but not likely. it sounds like he is not comfortable with doijng the procedure and I do not recommend that you get surgery.  you need to know that dermatologists began the use of cosmetic Botox along with an ophthalmologist and not surgeons

Melvin Elson, MD
Nashville Dermatologist
5.0 out of 5 stars 6 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.