Poor Dysport Results Last Time, is it Time for Upper and Lower Eyelid Surgery Instead? (photo)

Always had great results with Botox but went with Dysport last time and results were horrible. Made my eyes smaller, brow lower and lids super puffy. It's worn off now but my lids have become so hooded that they stick together, I raise my brow to see better and I always look mad (due to being 45, not result of Dysport). Do I go with Botox/Dysport again or get upper and lower lid surgery? Or given how my lower lids look, would fillers work instead? Thanks!

Doctor Answers 14

Upper Blepharoplasty not Botox or Dysport is required to correct Eyelid Hooding

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Thank you for your question. You have loose upper eyelid skin called Dermatochalasis which must be removed during an Upper Blepharoplasty in order to correct the hooding of your upper eyelids. No amount of Botox or Dysport injected into the frown line and the upper corner of the eyelids will allow the Brow to elevate and correct this.

If Botox or Dysport was injected into the Forehead-Worry Lines-this would actually make the Brow drop and the Upper Eyelid Hooding worse.

Poor Dysport Results Last Time, is it Time for Upper and Lower Eyelid Surgery Instead? (photo)

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The truth is there are several ways to treat you.  A lot will depend on what you want.  If Botox doesn't help you anymore (and this is not certain yet), then you may well need surgery.  You should get an in depth consultation with a surgeon who also injects Botox to see what is your best option.

Sam Goldberger, MD
Beverly Hills Oculoplastic Surgeon

Blepharoplasty and browlift

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By your posted story it sounds like the problem is more due to how the injections were made than what was injected, botox vs. dysport. Your current concern seems to be the hooding and that is not effectively or fully treated by botox or dysport. Those neurotoxins are best used to treat skin wrinkles caused by dynamic muscle action. Fillers will not do anything for the upper lid hooding. Therefore the only treatment that will give a reliable result is some combination of upper blepharoplasty and brow lift. You need to make sure that all of the neurotoxins are gone and the tissues have returned to their baseline level before having any surgery otherwise the results could be short lived. Since the upper eyelid skin hangs onto the eyelashes in some areas insurance may cover part of your surgery if you can prove directly related visual field deficits.

My response to your question/post does not represent formal medical advice or constitute a doctor patient relationship. You need to consult with i.e. personally see a board certified plastic surgeon in order to receive a formal evaluation and develop a doctor patient relationship.

Aaron Stone, MD
Los Angeles Plastic Surgeon

Alternative when Botox/Dysport does not work

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You have significant hooding of the upper lids from descent of the brow. To improve this, you need some way to elevate the brow. Botox/Dysport can sometimes do this if placed only in the muscles around the eye and not in the forehead (the muscles you need to elevate the brow) and teh forehead muscle is active enough to lift the brow. If you had the forehead injected, this could be one reason for the horrible results. If getting rid of the brow depressor does not result in brow elevation, then your only option is a brow lift of some kind. You need a consultation with an experienced brow and eye Plastic Surgeon who understands the anatomy and muscle function in the area.

Robert T. Buchanan, MD
Highlands Plastic Surgeon

Botox or eye surgery

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Even when i perform a blehparoplasty, Botox is still used for treatment of the facial lines of animation.  One does not replace the other.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Botox or eyelid surgery

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This is not an either or situation. Botox weakens muscle and may be helpful in the dynamic crows feet. The upper lid hooding can be approached with upper eyelid surgery, brow lift, or peels, in various combinations depending on what you desire as a result.

Robin T.W. Yuan, M.D.

Robin T.W. Yuan, MD
Beverly Hills Plastic Surgeon

Poor Dysport Results Last Time, is it Time for Upper and Lower Eyelid Surgery Instead?

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  Perhaps.  The photos, aesthetically, show eyebrows that are quite low in position with the left lower than the right. The degree of upper eyelid hooding will increase and decrease with brow position.  This degree of eyebrow drop combined with significant upper eyelid housing would most likely require a Brow Lift combined with an upper eyelid surgery IMHO.  Be sure the plastic and cosmetic surgeon, you select, understands and follows the proper aesthetics of facial beauty for the creation of a naturally, more attractive face and eye area.  

It sounds like the Dysport may have been injected a little too close to the eyebrow(s) causing them to droop which in turn increases the degree of upper eyelid hooding.  Hope this helps.

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.7 out of 5 stars 28 reviews

Eyelid rejuvenation options

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I'm sorry that you had a poor experience with Dysport.

To be honest, your result should be the same with either dysport or botox. I don't use Dysport a lot but the product does appear to provide a denser treatment affect than botox, even when comparable (adjusted units) amounts are injected. If the injector is not aware of this, an over-treatment can result, This sounds like your situation (brow ptosis and lid puffiness from an over treated forehead).

While  wrinkle relaxers can be used to raise your eyebrows, it typically only gives 2-4 mm of lift to the lateral or side of the eyebrow. Your upper lid issue appears to involve the whole lid and is probably 50% due to eyebrow position problems, not just the upper lids. Also, a botox brow lift might over arch your eyebrows, since they rise up laterally as a baseline. Botox would be better suited for making your left brow symmetrical with the right and probably not the best choice for your case. I would recommend an endoscopic brow lift and upper lid blepharoplasty. You would be happier with the upper eyelid contour with a surgery. Keep in mind that you still may require wrinkle relaxers for the frown lines and crow's feet, even after successul surgery.

Your lower lids do look like they would respond nicely to filler injections. That is probably worth some thought before lower eyelid surgery is considered.

Hope this helps and best of luck.

Richard W. Westreich, MD
Manhattan Facial Plastic Surgeon
4.9 out of 5 stars 55 reviews

Poor Dysport Results Last Time, is it Time for Upper and Lower Eyelid Surgery Instead? (photo)

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Photos doe demonstrate a possible need for a blepharoplasty, but try BOTOX again to maybe delay the surgery. But I think you would be more satisfied with a surgery. Good luck. 

Lid rejuvenation and Botox work in different ways

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Botox along the crow's feet area can tend to relax and raise the brow slightly and open the lid, though upper lid rejuvention works in a different way reducing skin hooding, improving upper lid 'show', and reducing fat or fullness in the inner lid. If Botox pleased you in the past, keep it up, though if the lid hooding is getting you down, it is time for blepharoplasty.

Best of luck,


Peter E. Johnson, MD
Chicago Plastic Surgeon
4.0 out of 5 stars 44 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.