I Recently Had Botox Injection to Forehead and Now my Eyelids Hang over My. Eyes,will This Be Permanent?

Question

Mark K. Markarian, MD, MSPH, FACS · Answer

I am unsure if you are experiencing eye-LID droop or eye-BROW droop that can sometimes cause skin gathering over your eyelid to mimic eye-LID droop.  Rest assured, both are temporary complications of Botox and WILL improve.Let's discuss both in more detail....A Droopy Eye-LIDA droopy upper eye-LID may occur 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. A lower dose typically diffuses onto the Levator muscle and so the other good news is that the eyelid droop will typically NOT last as long as the full Botox duration of 3-4 months, and may in fact resolve in less than a month. Note, however, that if the eyelid droop occurred shortly after injection (i.e. within 3-4 days), then your eyelid Levator muscle likely received a significant dose of Botox and your eyelid droop may not resolve for 1-2 months or more...On a side note, 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. During your consultation, your injecting physician should rule out both of these scenarios to ensure you are an appropriate candidate for Botox... Your thyroid disease is not a contraindication to Botox or to the treatment of your eyelid droop, which brings me to my next point...A droopy upper eye-LID due to Botox can be treated with Apraclonidine (aka Iopidine) eye-drops. These eye-drops are commonly used to improve Gluacoma – a condition of high “eye ball pressure”. However, besides lowering the pressure in the eye, Apraclonidine causes the Muller muscle in the upper eyelid to contract and lift the upper eyelid about 2mm.The usual dose of Apraclonidine 0.5% is 1-2 drops, 3 times per day until the Botox wears off. (Note, make sure you put in one drop at a time, tilt your head back, and close your eyes to make sure none of the eye-drop leaks out.) Apraclonidine should be used with caution in patients taking Beta-blocker eye drops (ex – Timolol), or certain pills for high blood pressure (such as Beta-blockers), Digoxin, and those taking MAO inhibitors (ex – Phenelzine) for Depression. Be sure your prescribing physician also discusses 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...A Droopy Eye-BROWA drooping eye-BROW may happen in the following scenarios:(1) When the brow-elevating muscle in the forehead, the Frontalis, receives too high a dose of Botox.(2) The Botox is sub-optimally placed too low in the forehead; it should typically be placed at least 1 cm above the Brow. (3) It may also happen if you have a low set eyebrow to begin with, in which case any Botox to the Frontalis increases the likelihood of a brow droop. Ironically, as mentioned above, a droopy eye-BROW from Botox can sometimes be improved with MORE Botox -- this time, the Botox is typically injected into the outside (top of the crow's feet) part of the eye (aka the lateral aspect of the Orbicularis Oculi muscle) to generate a bit of a brow lift in that area -- by injecting more Botox and paralyzing the orbicularis muscle that normally acts to depress the brow in that area, you may get a slight compensatory brow lift (and even possibly restore some of your natural eyebrow arch)...If the extra Botox does not improve the brow droop, it will likely last as long as the full duration of the Botox -- 3-4 months.When it comes to Botox, I would recommend seeking, at the very least, 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, how deep beneath the skin the actual muscle resides, and the patient variability therein. So, what kind of physician should be injecting your Botox? 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 as I commonly dissect under the skin, see the actual muscles themselves, and learn "first-hand" the incredible variability between patients -- live, "on the OR table" -- as opposed to via lectures or a cadaver dissection. For me, this helps guide where to inject and where not to. However, with that said, I know many non-aesthetic trained plastic surgeons and other physicians who know the anatomy well despite not operating in that area, and get good results.Good luck.Dr Markarian

Harold J. Kaplan, MD · Answer

Hi LW.  Not to worry, this will correct itself after a short period of time.  One of the side effects of Botox injections is Ptosis.  This normally happens with less experienced injectors as injection technique and amounts are important in avoiding this problem.  We suggest you visit your injector to see if they can help with the problem by doing a "chemical browlift", but if you do not have confidence in your injector or they don't normally offer this service then it may be best to just wait.  Good luck.

Mehryar (Ray) Taban, MD, FACS · Answer

Botox weakens muscles. When injected in the forehead, it weakens the forehead muscle. That can cause the forehead/brows to fall in those people that have underlying droopy brows. The effect is temporary since Botox effect is temporary (about 3 months). You can consider forehead/brow lift in the future to address the underlying problem.

Manuel A. Lopez, MD · Answer

Fortunately with Botox injections this look will not be permanent. This occurs when the forehead is overtreated and the brows drop. It is usually when people have horizontal wrinkles on their forehead and want to get a smoother forehead. The frontalis muscle elevates the eyebrows and causes the forehead wrinkles. By placing Botox in the muscle and over-weakening it the eyebrows will drop. This is an indicator that a browlift may be in your future if you want to have a smoother forehead. Rest assured though, your eyebrows will come back their normal position. Best Wishes.

Steven F. Weiner, MD · Answer

Heavy brows after Botox is related to:  too low an injection, too much Botox, or unrecognized brow problems before injection. Many doctors are tempted to inject foreheads which have a lot of creases but don't realize that the patient needs to lift brows to keep excessive overhanging lids from obstructing their vision.  If they inject these people, they will have a wrinkle free patient but an angry one because of low lids/brows. Best to give very little or nothing to these patients. In all case this gets better though.

I Recently Had Botox Injection to Forehead and Now my Eyelids Hang over My. Eyes,will This Be Permanent?

Answers (9)

Answer: Low brows

Answer: Low brows

Answer: Heavy eyebrows after Botox will resolve

Answer: Heavy eyebrows after Botox will resolve

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I Recently Had Botox Injection to Forehead and Now my Eyelids Hang over My. Eyes,will This Be Permanent?

Answers (9)

Answer: Low brows

Answer: Low brows

Answer: Heavy eyebrows after Botox will resolve

Answer: Heavy eyebrows after Botox will resolve

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Recommended reading

Everything you need to know about Botox

Our mission is to create a world where every investment in modern beauty is Worth It.