I have ptosis of the right eye which began 12 days after Botox treatment.

Question

I am experiencing ptosis of the right eye. I had botox treatment 10/20 and woke up to ptosis on 11/01. Is this to long of a period for it to be associated with botox. And if it is botox related how long might this take to recover?

Sue Ellen Cox, MD · Answer

I'm sorry to hear about your experience, and as others have said, no its not too late to be related.  Most neuromodulators take effect 7-14 days after treatment, with full effect at about 14 days. Although it may be technique related, you may also have an underlying predisposition to ptosis if your right side levator muscle is innately weak.  In most cases ptosis will gradually resolve within a month of onset.  Good luck, and be sure to mention this at your next treatment

Kenneth D. Steinsapir, MD · Answer

However, it is possible for the ptosis to last much, much longer.  I have seen cases that have lasted over a year.  While that is quite unusual, it should give you an idea of how variable this is.  Despite what has been posted by Dr. Emer's social media service which posted that you should have laser and radio frequency treatment for this condition, there treatments do not treat post botox ptosis. Iopodine is an eye drop that help open the eye and is often prescribed in this setting. However, it only works if enough of the muscle is working.  I use this drop to predict when the botox will wear off.  If you use the iopodine for a week and it is working to help open the eye, the ptosis is likely to wear off in 4 to 6 weeks.  However, if the drop does not work, it is likely that the ptosis will last 3 to 4 months or longer before wearing off.  Look into the Microdroplet Lift® which is associated with a very low risk of upper eyelid ptosis.

Francis Johns, MD · Answer

Thank you for your question.The ptosis you are seeing can be the result of the Botox injections. Typically Botox kicks in between 3-7 days but in some patients it can take 2 weeks to see the final result. Botox can then last for 3-4 months depending on the patient and how fast your metabolize it.

Daniel Barrett, MD · Answer

Dear yolanda360,Botox is generally an on off switch for muscle activity. Ptosis can be caused by Botox injections.Most of patients see first changes after 4-7 days and the final results after 10-14 days.It depends on the amount of Botox and area where it is injected but it usually last for 3-4 months.Daniel Barrett, MD, MHA, MS 
Certified, American Board of Plastic Surgery  
Member, Am. Society of Plastic Surgery

Jason Emer, MD · Answer

Ptosis can be improved with a combination of venus legacy, thermage and Iopidine drops. Botox results resolve in 3-4 months. See an expert. Best, Dr. Emer

Andrew T. Lyos, MD, FACS · Answer

Hello and thank you for your question.  Botox can take 7-14 days to take full effect.  This is certainly within that time frame.  I would recommend an evaluation with your injector.  Your injector will best know where the product was placed and what the next step would be.  Remember, botox will begin to wear off and this ptosis will also dissipate. I hope this information helps and best of luck to you!

Flora Levin, MD, FACS · Answer

Unfortunately it is possible to get a droopy eyelid after botox injection. It can be seen as early as the first 48-72 hours or after 1-2 weeks, when the injection reaches its full effect. The ptosis will gradually resolve as the Botox wears off. An eye drop called iopidine may help improve the ptosis temporarily - speak with the doctor. It does not mean that you will get ptosis again after another treatment if it happened once.  However, if I see a patient who had ptosis more than once (with different injectors), I do not recommend that the area be treated.

Haena Kim MD, FACS · Answer

Ptosis of the right eye happens when injections in the glabella or "eleven" lines drifts down and affects the levator musculature of the upper eyelid. This results in a heavy eyelid that can obscure the iris (colored portion) of the eye. Sometime treatment of the forehead itself results in a dropping of the eyebrow, not the eyelid, and this is often confused with ptosis of the eyelid. 
The big difference here is if there is true ptosis of the eyelid, you can use eye drops (lopidine) to help stimulate an alternate muscle to lift the eyelid. The results of the drops are temporary. The goods news is that ptosis is temporary as well. It should begin to lessen over the next several weeks where it may not be as bothersome, and rest assured it will wear off in 3-4 months, depending on how much botox was used. Good luck!

Sudeep Roy, MD · Answer

Hi and thank you for your question, we appreciate you sharing your concerns. Brow or eyelid ptosis is certainly a risk of Botox wherein the Botox diffuses into a muscle you did not intend to weaken (such as the levator palpebrae superioris which contributes to lifting up the upper eyelid). This may be secondary to improper placement, over aggressive treatment or simply bad fortune. The good news is that the ptosis that you are exhibiting is temporary and will generally resolve within 3 months, as the Botox loses its efficacy. Eye drops to stimulate Muller's muscle (another muscle that helps elevate the eye) can assist with temporary improvement in the ptosis while you wait for the Botox to wear off. Your doctor (or medical director of the practice you received your treatment in) can advise you on these medications. Hope that helped! Best, Dr. Roy.

Melvin Elson, MD · Answer

Ptosis can occur at this late date and can be treated with Iopidine drops to improve it  Dont opt for expensive treatments to treat this temporary problem even though it may last a few months

I have ptosis of the right eye which began 12 days after Botox treatment.

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