Could pressing/blotting one of the Botox injection sites several times cause it to spread to my eyelid, causing it to droop?

The nurse told me that one of three places bled a little, and gave me a tissue in case I needed it. After I pressed the tissue on it a few times, she stopped me and told me that I should not press on it. Uugh! Why didn't she tell me that first? Could this cause a droopy eyelid problem. This is my first time using Botox and I am worried.

Doctor Answers 5

Could pressure on the Botox site cause eyelid droop?

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.

Botox and pressure on injection site

Botox is a great tool to diminish lines in the face.  Mild pressure to control bleeding will not make your eye droop. We generally give patients ice packs to control swelling and bruising after injections.  Please consult a board certified dermatologist for the best cosmetic results.

Michele S. Green, MD
New York Dermatologist
5.0 out of 5 stars 76 reviews

Pressure on Botox Sites

It is very unusual for eyelid drooping to occur after Botox is properly placed.  Gentle pressure on the Botox site to control bleeding or oozing should not result in the spread of Botox to the muscles which control eyelid position. Again, it is important to have Botox administered by a skilled professional who knows how to achieve great results and avoid complications.

James Clayton, MD
Salt Lake City Plastic Surgeon
4.0 out of 5 stars 6 reviews

Pressing the Botox sites

It is important not to press hard or rub the injection sites that might mobilize the botox to an area where it should not go.  However gentle pressure to discourage bleeding and ecchymosis ( black and blue areas) will not do any harm and certainly should be done if needed. Correct amounts of Botox, properly placed, rarely effect the levator muscle and cause drooping.....I would not worry.

Richard Galitz, MD, FACS
Miami Facial Plastic Surgeon
4.6 out of 5 stars 11 reviews

Eyelid Dropping after Botox

When eyelid droop occurs after a Botox injection, it is generally due to the spread of the toxin into the levator muscle which holds the eyelid position.  This muscle which is present underneath the eye socket is remote from most Botox injections.  However, if there is bleeding or excessive pressure from pressing or blotting on an injection in the upper eyelid region, it is theoretically possible for some of the toxin to reach this muscle and cause droop.  The good news is, over time, this eyelid droop is entirely reversible and should prove much quicker then the normal amount of time it takes for a Botox to wear off. 

Scott Wells, MD
New York Plastic Surgeon
5.0 out of 5 stars 5 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.