Let me start by saying you will likely be just fine, so don't worry. Gentle pressure on a Botox injection site will rarely cause eyelid drooping.Eyelid droop typically occurs if the Botox is injected too close to your eyelid-elevating muscle, the levator palpebra superioris. In such a scenario, the Botox will diffuse inadvertently onto the levator muscle and cause an eyelid droop. Vigorous massage or excessive pressure may also cause the Botox to diffuse onto the levator muscle IF the site injected is low and close to the eyelid...Alternatively, you may have an increased risk of eye-LID drooping if you have a weakened upper eyelid muscle for neurological reasons, or a deeply set eye-BROW that would be more prone to drooping and result in skin gathering over the eyelid making the eyelid appear like it was drooping. In such cases, even though the amount of Botox injected into the forehead is within normal limits, if the injector does not identify the low set brows, the Botox will have an untoward effect...Regardless, even if you were to develop a droopy eyelid from Botox, this is typically NOT permanent. Yes, it is extremely inconvenient, but it can be treated with Apraclonidine eye drops that may raise your eyelid up to 2mm. If you are ever in such a situation, be sure your prescribing physician discusses all the potential side-effects of the drops, such as "adrenaline-like" symptoms like anxiety or heart pounding; you may also experience eye irritation, eye dryness, and eye pain, amongst other symptoms. If these symptoms occur, you will likely need to take some lubricating eye drops, lower the dose, switch the eye-drops, or stop the drops altogether...In the future, be sure to seek the services of an experienced physician injector. I think the key with Botox lies in truly understanding the anatomy of the injected area, and more importantly the variability in the anatomy between patients -- for brows, the forehead, and anywhere else you plan on receiving a Botox injection. This includes having a firm understanding of the origin, insertion, and action of each muscle that will be injected, the thickness of each muscle targeted, and the patient variability therein. As an aesthetic-trained plastic surgeon, I am intrinsically biased since I operate in the area for browlifts and facelifts, and have a unique perspective to the muscle anatomy since I commonly dissect under the skin and see the actual muscles themselves. For me, this helps guide where to inject and where not to. However, with that said, I know many Dermatologists who know the anatomy well despite not operating in that area, and get great results.
