Ptosis from Botox injections - what can be done?

There are two types of Ptosis resulting from Botox.The first involves botox drifting from the forehead over the upper rim of the eye socket and into the eyelid where it affect the lifting muscle of the lid known as the Levator muscle.This has to resolve on its own but can be helped by using Naphcon-A eye drops which works to raise the eyelid a little bit by affecting a 2nd eyelid lifting muscle known as muellers muscle which lies on the deeper portion of the eyelid and wouldn't be affected by botox but can be affected by eyedrops placed on the eye.The second would involve a brow dropping into the eyelid space. This is common with less experienced injectors. This would require time to resolve but could be helped slightly by injecting the brow depressors if they weren't treated originally. I hope this was helpful.

 Unfortunately there is not much that can be done about brow ptosis once you have had Botox. You will have to wait until it wears off in about 3 to 4 months. 

Thank you for your question. Unfortunately time is the best option, in 3 months the results from your Botox should start to fade. It is not unreasonable to discuss options with your injector - although there may not be much he can do at this point. All the best,

Thank you for your question, and I am sorry that you have suffered this setback after Botox administration.  There are eyedrops that can be taken that will help improve the ptosis of your upper lid temporarily until the Botox has worn off sufficiently that your eyelid functions normally again (normally a couple to a few weeks).  See your injector, they can supply you with the medicine, and voice your frustrations, they may be able to work with you.  

Thank you for your question pellman222. I understand your concern. Botox is a purified protein used to address wrinkles associated with facial expression. When injected into the skin Botox will relax the muscles and smoothen out the overlying wrinkles. The most common areas of treatment are in the upper face. These include the horizontal lines seen on the upper forehead when one raises the brows, the vertical lines seen between the brows when one frowns (frown lines), and the crow's feet seen around the eyes when one smiles.
It is difficult to make an assessment in the absence of consistent photographs before and after in the same lighting and angles for comparison. However, I hope the information provided here is useful.In addition to addressing various wrinkles, Botox can also be used to adjust the position and shape of the eyebrows. It works the same way as it does when addressing wrinkles, namely by relaxing muscles. In the upper forehead, there are muscles that move the eyebrows up and other muscles that move the eyebrows down. The muscle that moves the eyebrows up is on the upper forehead; this is called the frontalis muscle. It is responsible for the horizontal lines seen on the upper forehead when one raises the eyebrows. The muscles that pull down on the eyebrows are located between the eyebrows and at the corners of the eyebrows. The muscle group between the eyebrows is called the glabellar complex. There is another muscle that goes around the entire eye called the orbicularis oculi muscle. The portion of this muscle under the tail of the eyebrow is responsible for pulling down on the tail of the eyebrow. When any of these muscles is relaxes with Botox the position of the eyebrow can be adjusted. When treating the horizontal lines on the upper forehead seen when one raises the eyebrows, if the dose is too high or if the placement of the product is too low it can lead to the feeling of a heavy eyebrow, difficulty raising the eyebrow, or downward movement of the eyebrow. This can also lead to downward movement of the eyelids, making a person appear tired. It also can make it difficult to apply eye makeup. To correct this Botox is placed in the antagonistic muscles, those in the glabella and orbicularis oculi which pull down on the eyebrows. This will raise the position of the eyebrows. These two areas can be treated with Botox to provide a brow lift. To do so 4-20 units of Botox are used in the glabella between the eyebrows and 2-12 units of Botox per side are used at the tail of the brow and/or the entire crow’s feet region.
When Botox is used in the upper forehead, if the dose is too high or the placement is too low it can result in the feeling of heaviness in the eyebrow or even lower the position of the brow. In order to reduce the risk of this possibility, I use a conservative dose in the area and place the product high on the forehead, sometimes near the hair line. Additionally, I recommend that my patients simultaneously receive a small amount Botox between the brows and at the corners of the brows. This will relax the muscles that pull down on the brows to counteract this effect and provide a harmonious balance to the position of the brow. The results are assessed two weeks after the treatment. If there is any asymmetry a small amount of Botox can be placed in the upper face for correction.

Sometimes after a Botox treatment a peaked appearance of the eyebrow is seen. This is sometimes called the Spock or Mephisto look, which makes a person appear surprised or sinister. It is also called the Jack Nicholson look, after the appearance of his eyebrows. This can occur if the muscles that pull the eyebrow down are relaxed with Botox. It can also occur if the upper forehead only is treated. In this case the inner portions of the muscles are relaxed preferentially over the outer portions of the muscle. This allows the outer portions of the muscle to pull up on the tail of the eyebrow. While some people desire this appearance, others do not. This effect can be corrected by placing a small amount (1-2 units) of Botox in the upper forehead approximately midway between the eyebrow and the hair line at the peak of the brow. This relaxes the muscle that pulls up on the tail of the eyebrow, thereby restoring a natural appearance.
The muscles that are treated with Botox around the eyes are close to the muscle that lifts the upper eyelid. If this muscle is affected it can lead to a temporary droopy eyelid (blepharoptosis). The duration depends on the placement of the product and the dose used. Usually it resolves in 2 weeks, but it can last up to 4 months. Blepharoptosis can be treated with apraclonidine 0.5% ophthalmic solution (also known as iopidine) and various other medications. For my patients, I recommend 2-3 drops to the affected eye 2-3 times per day. When the blepharoptosis begins to wear off patients notice less of a droop when waking up in the morning after the last dose of apraclonidine has worn off. The incidence of blepharoptosis is reported to be approximately 1% but in my experience, I find it to be about 0.1%. This is likely due to the fact that when these studies were initially performed injectors may have not been as aware of this adverse effect nor been taking extra precautions to avoid it. Blepharoptosis occurs when Botox is placed near the eye and it diffuses to the muscle that lifts the upper eyelid (levator palpebrae superioris). This is located inside of the orbital rim above the globe. To avoid this side effect, I place the product at least 1 cm from the orbital rim. When placing product between the brows I pinch the area to be treated and lift it so that the product is placed in the muscle and is less likely to diffuse around the bone into the orbital space. Diffusion into this area may also be caused by other preventable things. For this reason, I recommend that my patients carefully follow the simple aftercare instructions described below. This may be a reason for the low incidence of side effects in my practice.If I had a patient with the concern described here I would first want to see before and after pictures to determine if it is the eyebrow that is droopy (which can lead to hooded eyelids) or the eyelid itself. Depending on this, one of the treatments above may be appropriate. In our office we take care of patients who are not happy with their results with complimentary additional units it necessary. Each office has its own policies.With any injection, there are risks such as pain, bleeding, bruising, redness, swelling, tenderness, and infection. We take special precautions to minimize these risks such as using a painless technique. We also treat bruises with a laser as early as the next day. Bruises usually resolve within two weeks if untreated. After a laser treatment bruises usually resolve in 1-3 days, but may still take two weeks for full resolution. In addition to these risks, with Botox there is also a risk that the product spreads or diffuses to nearby structures. Spread to nearby muscles can lead to side effects such as the temporary appearance of droopy eyelids or a temporary asymmetric smile.

After a Botox treatment, I recommend that my patients avoid heat exposure, alcohol consumption, and strenuous exercise for 24 hours and not lie down flat for four hours. This is because all of these activities may possibly lead to the movement of the product and consequent side effects such as droopy eyelids. Although there have been no definitive studies shown that these actually occur and some physicians do not provide such aftercare instructions, in the absence of data I err on the side of caution and recommend that my patients avoid such activities.

Please consult with a doctor for specific recommendations. Good luck!

If you have eyebrow ptosis as opposed to eyelid ptosis, you can do something rather than just wait for to go away. You should go back to the doctor and have them put more Botox into the glabella area. This will cause your eyebrows to raise and you will feel better and look better also.

Ptosis can happen to even the most experienced injector but I can say with confidence that I rarely see ptosis in my hands.  I use conservative amounts of Botox and am very precise with my injection points.  I like to tell my patients that I can always put more in, but I can't take it out.  The good news is that all side effects from Botox resolve over time.  

Performing cosmetic procedures is often more an art than a science.  Results can not always be guaranteed but if you are unsatisfied with your result see a follow up check with the individual who delivered the treatment, and express your concerns/disappointment.  From there, there may be many options (more Botox, drops, other procedures, etc) that may help you to achieve "the look" you desired.  The unwanted side effects of Botox will resolve.  The rate of improvement will depend on the amount of Botox used, and the location in which it was placed.   

Hi, Sorry to hear about your ptosis (droopy eyelid) following Botox. This is a rare complication of Botox injection around the eyes (commonest due to treatment of frown lines). It occurs due to the unwanted action of Botox on the muscle that lifts the eyelid.You would often find physicians mentioning about a drop to reverse it, but as an eye plastic surgeon I can tell you, that these drops do not work. Earlier, Guanethidine eye drop was recommended, which is not easily available from any pharma company. Another drop used by eye doctors to raise the eyelid is Phenylephrine. However, it would barely raise the eyelid by a millimeter or two, lasting for maximum 2-5 minutes. Thereafter, it dilates your pupil (the aperture of our eye that controls light entry) making you light sensitive for hours. Not to mention, frequent use of phenylephrine drops can increase its blood levels in your body, thereby marginally raising your blood pressure.Therefore, the best treatment for ptosis following Botox is to wait until it disappears. Ptosis generally disappears within 2-4 weeks; mush faster than the desirable effect of Botox.Experienced injectors know how to avoid causing Ptosis during Botox injections. However, it can happen occasionally in the best hands.

Hello Pellman222,Sorry to hear about your ptosis.  There are eyedrops which can be prescribed to help raise your eyelid.  They do have to be used multiple times per day.  Usually the ptosis goes away within a few weeks but sometimes it lasts the entire time that the Botox does (about 3 months).  I would not anticipate your provider would provide a refund as this is a known risk of the procedure.  When injected by an experienced injector this is a very rare side effect although it can occur to anyone.  I would recommend you discuss your concerns with your injector to review your options.  You may also consider future injections with a facial plastic surgeon, plastic surgeon, oculoplastic surgeon, or dermatologist as these will tend to have the most experience and are also physicians.  I hope this helps and good luck.