Heavy left eyelid from Botox. What are they doing wrong? (Photo)

This is the third time from three different Plastic Surgeons and I still end up with puffy lids what are they doing wrong??? The last time I received 40 units

Doctor Answers 13

Heavy left eyelid from Botox. What are they doing wrong?

In terms of the heavy left eyelid -- this is not a ptosis of the lid.  What is happening is that the Botox is unmasking your naturally low lying brow/ excess upper lid skin.  You likely subconsciously keep your forehead in an elevated state without the Botox to keep your brow and upper lid in a higher position.  When the Botox is in effect, you can no longer do this, and things fall down -- you have now exchanged your forehead wrinkles for a lower brow and lid.  

I would avoid forehead injections or just get a small amount injected very high on the forehead (will improve but not eliminate forehead wrinkling).  This may be an indication that it's time for a brow lifting procedure and/ or an upper eyelid surgery.  

Choosing a "core" Botox injector will be the most important step in ensuring that you were assessed correctly and treated in the proper manner (facial plastic surgeons, plastic surgeons, dermatologists, or occuloplastic surgeons). This is because we all have a keen understanding of facial anatomy and the effects of injecting Botox/ Xeomin/ Dysport and fillers in different regions of the face.  Be sure you are seeing a plastic surgeon or facial plastic surgeon in your case so that they can assess whether you are an ideal candidate for surgery at this time.

Good luck!


New Orleans Facial Plastic Surgeon
5.0 out of 5 stars 42 reviews

Botox injections and Forehead NYC

It appears from the description that you may need less Botox in your forehead or higher up. It is also possible that you are not good candidate for Botox in your forehead and you should avoid it.  An in person evaluation is really the only way to assess this.  I have seen a lot of patients who had the same experience and have found them not to be good candidates for Botox.  Best, Dr. Green

Heavy left eyelid from Botox. What are they doing wrong?

Hello Tuneitup,

Based on your description and photos it sounds like your brow is naturally in a low position.  Your forehead muscle is likely always working to keep your eyebrows out of your eyes.  Once you receive the Botox the brows return to their natural position given you this heaviness.  You have two options to get around this.  The first is less Botox and higher up on your forehead.  This will still leave wrinkles lower on the forehead but it will keep your eyebrow up.  The other is to have a brow lift procedure.  This will bring your eyebrows to a more youthful position at rest.  This way you can still use Botox to help with the active wrinkles.  

I hope this helps and good luck.  

William Marshall Guy, MD
The Woodlands Facial Plastic Surgeon
5.0 out of 5 stars 25 reviews

Lid fullness

If your lids are dropping then it may mean that your forehead muscles are possibly not strong enough to keep them up after botox. You may need a brow lift or less botox and higher up on the forehead. Best to be evaluated in person.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 24 reviews

Mild upper eyelid ptosis after Botox

Unfortunately some Botox has diffused down and affected function of your upper eyelid. The good news is that it will go away and open and close eye exercises can make the effect go away sooner. 

Dr Karamanoukian
#RealSelf100 Member

Botox Complication

So sorry this happened to you. Occasionally, the Botox drifts down and affects the upper lid muscle causing drooping. The good news bad news about Botox is that it is not permanent, and will go away and your lid will return to normal, but it may take a while, 1-2 months. Ask your injector about eye drops that temporarily lifts the affected lid somewhat for limited use for special occasions like an important meeting or a social event. Do not let anyone inject more Botox to try to fix it, because it does not work, and can increase the time that the lid stays down. Try and be patient as it will get better! Hang in there.

Robert M. Tornambe, MD
New York Plastic Surgeon
5.0 out of 5 stars 24 reviews

Heavy left eyelid from Botox

Thanks for your question.

Cosmetic Botox in the forehead is generally used to correct vertical lines and what might be called the 11 lines between the eyebrows. With that in mind, Botox given in these areas needs to be balanced. Judging from your photo, it seems that you may have some extra skin on your upper eyelids. Because of this, Botox on you needs to be done in a very conservative manner. The downside for you is you may have to tolerate some lines in order to not have your eyelid skin seems so heavy. Moving forward, you may want to consider less Botox in the forehead and perhaps at one point a cosmetic surgical procedure such as an upper blepharoplasty to remove a bit of extra skin on the upper lids. Best of luck.

Heavy brows after Botox by 3 different docs

You need your forehead to have the ability to move to allow for brow elevation. By relaxing the wrinkles in your forehead, you can't compensate for the underlying heavy upper lids. Also, the pic appears to show the treatment has caused medial brow lowering and this is contributing to the problem. Too much was placed in the glabellar area too high and has dropped this area as well. Next time, probably don't get forehead injected, get glabella injected "low" and include crows, brow lift, and depressor supercilii injections.

Steven F. Weiner, MD
Panama City Facial Plastic Surgeon
4.6 out of 5 stars 27 reviews

Heavy Eyelid After Botox

They are likely doing too high dosing or you are not the best candidate for botox injections.  Please see an expert for treatment.  Best, Dr. Emer.

Jason Emer, MD
Los Angeles Dermatologic Surgeon
4.9 out of 5 stars 167 reviews

Low Eyebrows Following Botox Injections

Thank you for asking your question. Unfortunately, too much Botox was injected in your forhead or it was injected too low in the forhead. Make sure your injector is highly experienced with this region of the face. Good luck,

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.