Questions About Ptosis Caused By Botox

For injections of Botox to raise the medial portion of brow, what are the chances the reverse will happen? (The brow drops). What if some of the botox travels to the eyelid muscle? This would cause droopy eyelid, but at the same time, the brow lifts up which lifts the eyelid as well, correct? So the ptosis that occured would not be that noticable (can be corrected by drops). How to reduce the chances of botox spreading to eyelid? (Besides an experienced plastic surgeon, of course)?

Doctor Answers 7

Botox and Ptosis

Eyelid ptosis and brow ptosis are separate phenomenon. Eyelid ptosis occurs when Botox diffuses (spreads) to the Levator muscle in the eyelid and causes the eyelid to droop. While this is a temporary complication, it can be frustrating. Iopidine drops can temporarily relieve the ptosis however time is the only true cure. It can take up to or longer than six weeks to resolve. Ptosis can happen even when flawless technique is applied. Some of the measures taken to avoid ptosis include staying well above the supraorbital rim, avoiding massage after injection, animating the muscle while injecting, and avoiding injecting too low in the forehead.

Newport Beach Facial Plastic Surgeon
5.0 out of 5 stars 34 reviews

Eyelid ptosis vs brow ptosis

Eyelid ptosis is very different than brow ptosis. Eyelid ptosis happens when the levator muscle accidentally gets paralyzed by the botox.  Brow ptosis can happen if too much botox is used ont he brow and it descends too much.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 29 reviews

Eyelid ptosis occurs rarely after a Botox treatment to your frown muscles.

In my hands, the likelihood of ptosis is less than 1% of treatments to the glabella. Botox related ptosis lasts around 6 weeks, and may respond to Iopidine or phenylepherine drops. As you suspect, the experience of your physician is important when considering Botox treatments.

Eric M. Joseph, MD
West Orange Facial Plastic Surgeon
4.9 out of 5 stars 421 reviews

Avoiding eyelid droop

Studies have shown that Botox injected into the inner eyebrow region does lift the forehead as the muscles in this area are forehead depressor muscles. Botox injected into the glabella (between the eyebrows) should not diffuse to the region near the eyelid. If, however, an insertion is placed above the mid eyebrow, and it is too low and close to the eyebrow, and if the dilution chosen by the physician is substantial, thereby making it necessary to inject a larger volume, then there would be a risk of eyelid droop. Experienced physicians can all see complications but they are very rare, especially if large dilution volumes are avoided.

Ronald Shelton, MD
Manhattan Dermatologic Surgeon
4.9 out of 5 stars 38 reviews

Ptosis with Botox happens rarely

I beleive the incidence of ptosis from Botox is about 3%. Going to a board certified dermatologist or plastic surgeon well versed with the product reduces, but can never eliminate the risk of complications. Aiming the needle up, avoiding massage, and placing above the orbital rim are tricks to reduce the risk.

Mary P. Lupo, MD
New Orleans Dermatologist
5.0 out of 5 stars 18 reviews

Botox and Ptosis

As noted by Dr. Placik, the best effect of brow elevation is achieved in the lateral brow area via inhibition of the lateral preorbital orbicularis oculi, which is a relative brow depressor. When Botox is applied to the glabella, the inhibition of the corrugator supercilli muscles leads to a slight widening of the intrabrow space. Avoidance of injection associated ptosis is achieved by seeing an experienced Botox injector, minimizing volume per injection site (typically 0.1 mL, using 5 u per 0.1 mL), avoiding "low injections" in the frontalis muscle, having the patient activate the muscle while injecting it, and asking the patient to avoid rubbing the injected site for at least 12 hours afterward.

Ptosis caused by Botox injection should be a very rare event.  Ptosis is not "corrected" by drops; the effect of iopidine only lasts for a few hours and will help a patient for brief social encounters. 

Stephen Prendiville, MD
Fort Myers Facial Plastic Surgeon
4.8 out of 5 stars 95 reviews

Botulinum toxin injection and avoiding the ptosis effect

Generally speaking the botox is used the raise the :LATERAL portion of the brow and not the medial portion. A subtle elevation can be achieved by injecting the procerus which may have a depressor function on the medial brow. Using hihly concrentrated Botox (10 units per 0.1ml) and injecting extremely small quantities to minimize the diffusion effect is probably the best way to minimize unintentional spread. But the only surefire way is to be a at least 3cm from the muscle.

Otto Joseph Placik, MD
Chicago Plastic Surgeon
4.9 out of 5 stars 82 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.