Overactive eyebrow and smaller eye on one side. Worse after botox used to lower overactive eyebrow muscle. Best fix?

Question

I have had an overactive eyebrow for as long as I can remember. I am a 24 year old female. I had an online consultation where the doctor said I had ptosis but he does not do the surgery. I went to one that does but he said it’s not necessary for me and gave me botox instead. I feel like my eyes are even smaller now after the botox. My eyelid feels heavy and like something is in its way a little, even from before the botox but now even more. Is my case really something surgery wouldn’t fix?

Kenneth D. Steinsapir, MD · Answer

A responding doctor suggested Upneeq. In my opinion, this is a very expensive drop that is quite disappointing. It is not really a solution to your issue. You have significant upper eyelid ptosis. It is a little worse on the left side than the right. consequently you have more eyebrow compensation (elevation on the left). The doctor who suggested you have botox instead of surgery does not understand upper eyelid ptosis in my opinion. Your pictures suggest you have a particular type of upper eyelid ptosis caused by central disinsertion of the levator aponeurosis, the tendon that inserts into the eyelid tarsus. That means something because this type of ptosis does not respond well to the posterior approach ptosis surgery (so-called scarless ptosis surgery). That is because the tendon is not correctly positioned in the eyelid to respond well to the shortening of the posterior surface of the eyelid. For this reason you need an anterior levator resection ptosis surgery. I also recommend letting your botox wear off for at least 6 months before having any surgery because this treatment can affect the assessment of the eyelids and interfere the surgical outcome. In addition, you should have your upper eyelid crease lowered and have anterior orbital fat advanced into the eyelid if at possible to help establish more of an outie upper eyelid fold. Your eyes can be your best feature.

Jason Emer, MD · Answer

For unique cases where a variety of modalities could be used to treat the condition, I would suggest an in-person or virtual consultation to develop a custom and effective treatment plan.  It is difficult to precisely define the best option without collecting the same information. I suggest reaching out to an expert for a consultation with surgical and non-surgical methods to get a comprehensive option. Best, Dr. Emer.

Camille Cash, MD · Answer

From your photos it appears you have eyelid ptosis.  The Botox could address an overactive brow but it will not improve your ptosis.  Surgical correction is the most permanent solution to your concerns.

Eric M. Joseph, MD · Answer

I suspect that you're hyperactive left eyebrow is due to the fact that you're left eyelid ptosis is worse than your right. In that regard, I would recommend that you visit several reputable oculoplastic specialists who understand upper eyelid ptosis and how to repair it. Hope this helps. Sincerely, Dr Joseph

Jo Herzog, MD · Answer

There's a new eyedrop that can raise your lids. I would try this. Hopefully you will get some raising of your lids pretty easily.

Overactive eyebrow and smaller eye on one side. Worse after botox used to lower overactive eyebrow muscle. Best fix?

Answers (5)

Answer: Based on your photos, you may have upper eyelid ptosis, left side worse than right.

Answer: Based on your photos, you may have upper eyelid ptosis, left side worse than right.

Answer: Raise your lids with Upneeq

Answer: Raise your lids with Upneeq

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Everything you need to know about Botox

Our mission is to create a world where every investment in modern beauty is Worth It.

Overactive eyebrow and smaller eye on one side. Worse after botox used to lower overactive eyebrow muscle. Best fix?

Answers (5)

Answer: Based on your photos, you may have upper eyelid ptosis, left side worse than right.

Answer: Based on your photos, you may have upper eyelid ptosis, left side worse than right.

Answer: Raise your lids with Upneeq

Answer: Raise your lids with Upneeq

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Recommended reading

Everything you need to know about Botox

Our mission is to create a world where every investment in modern beauty is Worth It.