Ptosis getting worse 3 months after Botox?

Question

Got Botox for the 1st time 3 months ago into forehead, glabella and crows feet. I noticed eyelid swelling/ptosis the next day. My eyes are sunken into my forehead and my eyelid skin has been drooping. Today I noticed that the eyelid skin over the outside corner of my right eye seems to be drooping more...is this even possible? Really scared...still can't move my glabella lines where most of the Botox was injected...will my eyes ever look the same and how much longer do I have to live like this?

Garrett Griffin, MD · Answer

NeverAgain:  I am sorry this happened. Ptosis means "low." You can have eyelid ptosis or brow ptosis after botox.  Brow ptosis is probably more common...this is when the muscle that raises the eyebrows (the frontalis) is weakened so much that it can't pull the eyebrows up very well.  This is a common error in injecting botox.  In an effort to get rid of all forehead wrinkles, the injector completely paralyzes the forehead causing the eyebrows to hang low, making people look more tired and less attractive.  Interestingly, you can get a little brow lift from injecting botox just under the eyebrow to weaken the muscle that pulls down on the eyebrow.  This is one of my favorite techniques. Eyelid ptosis is relatively rare and depends on botox getting pretty deep inside the upper eyelid to the muscle that holds the actual eyelid up (the levator).  There are tips and tricks to avoid this, but it is sometimes just bad luck.It sounds like at first you had eyelid ptosis and now are getting some eyebrow ptosis.  Possibly, you had achieved a little bit of an eyebrow lift from the botox and now that is wearing off.  If your eyelid has fallen noticeably and it stays like this after the botox wears off, it is possible that something medical is going on, and you should see your doctor.  This round of botox should be completely out of your system in a couple weeks.  Consider giving a different, experienced injector another try. Best of luck.

Michael A. Zadeh, MD, FACS · Answer

It is important to follow up with whoever did your injections. Hopefully before and after pictures were taken to track your progress. At your follow up, the before and after pictures can be compared to see if the drooping of your eyelids have actually gotten worse. Everyone metabolizes Botox at different rates, but assuming that the cause of your ptosis is from the Botox injections then it should usually return to normal after 4 months. Good luck!

Michele S. Green, MD · Answer

Ptosis is a potential side effect of Botox.  Generally speaking the ptosis should not last more than 3 or 4 months and when the Botox is completely gone so is the ptosis.  I would be surprised if it is getting worse but I would return to your dermatologist for examination if you are concerned.

Samer W. Cabbabe, MD, FACS · Answer

Generally speaking, Botox injected into the depressor muscles in the glabella does not cause brow droopiness.  However, Botox injected into the forehead muscles which elevate the brow can cause droopiness.  Usually this will improve over time as the Botox weakens.

David A. F. Ellis, MD · Answer

Go see your MD that injected you to be re-assessed. How long it lasts depends on how much was injected, and where it was injected, and when was the onset.

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Ptosis getting worse 3 months after Botox?

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