Is it possible to have ptosis 8 days after botox (dysport), without any previous indication or symptoms prior?

Question

I had an allergic reaction and a rash 24 hrs prior to the ptosis and can't figure out if this is a swelling in my right eye due to the rash or a symptom of the botox. I assume if it's an allergic rxn I would have it in both eyes?

Matthew Bridges, MD, FACS · Answer

It is certainly possible to have ptosis after 8 days.  I can take up to 2 weeks to achieve the maximum effect, but 8 days is plenty to start seeing something.  Pictures would be useful to help figure it out.  You should definitely go see your injector and have them take a look.

Nelson Castillo, MD · Answer

Thank you for sharing your question and I am sorry to hear of your eyelid sagging. The neuromodulators can take a full two weeks to take effect so it is possible that the ptosis was related to your botox treatment.  Talk to your injector they can help by prescribing eyedrops that can help lift your lids temporarily.

Carlos L. Wolf, MD · Answer

It is  likely  that the ptosis you have is related to your injection of Botox. Botox and Dysport can cause ptosis, although rate with experienced injectors . The only thing that would concern me is the rash and the inflammation  you have around your eyes. This kind of reaction is very rare. I would consult an ophthalmologist to make sure that there is not another problem occurring around your eye.

Jack Berdy, MD · Answer

Eight days is certainly within a reasonable time frame to see the development of lid ptosis.  A picture would be very helpful to differentiate if this is true lid ptosis, brow ptosis, or swelling.  True swelling would more likely be associated with rash or allergy where lid ptosis would be a lowering of the upper eye lid, and brow ptosis would be a lowering of the brow.  You should see a physician since some of these potential causes may be treated.  Best wishes.
  
Dr. Berdy

Steven Wallach, MD · Answer

It takes about 5-7 days for botox to work completely.  If you haver an allergy to rash, tis might contribute to swelling but should not cause ptosis.

Melvin Elson, MD · Answer

This is not an unusual situation as ptosis can occur from injection of Botox anytime within a 2 weeks period. i doubt that allergy is related. See your doctor for Iopidine eye drops

Wayne Wertheim, MD · Answer

this is most likely due to the botox injection. The Botox is peaking in intensity from 7-14 days so it is on the timeline.
this could be from the injection being off by just a few millimeters. the good news is that as the botox wears off over the next few weeks the problem should improve and eventually go away completely

William Marshall Guy, MD · Answer

Hello Molly8212,
You would not develop an allergic reaction 7 days after botox or dysport treatment.  Some will develop a reaction when the Botox has been mixed with saline that had a preservative in it.  This would take place wihtin the first few days.  The fact that you noticed a rash and swelling a week later woudl raise the question if something else caused it.  Since you are having swelling it would be hard to say if you are having a true ptosis from Botox, which would develop around day 7, or if you are having drooping from swelling.  If it is from Botox there are some eye drops that can be used until the result wears off.  If the result is simply from swelling, then it will resolve as the swelling goes down.  I'd recommend you follow up with your injector to be evaluated.
I hope this helps and good luck.

Alex Eshaghian, MD, PhD · Answer

Thank you for your question molly8212. I am sorry to hear about your situation and 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 without a
formal exam in the office where I can view the skin in multiple angles and
observe wrinkles formed with facial expression. However, I hope the information provided here is helpful.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.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). Similar to the onset of full results, the onset of blepharoptosis can be seen as late as 14 days after the treatment. 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.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 as described above. 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!

Fereydoon S. Mahjouri, MD · Answer

I agree with you, Your eyelid ptosis only on one side could not be due to allergic reaction. Most likely it is due to the site and Technic of injection. In few weeks it will improve by itself and you should not worry too much about it.

Is it possible to have ptosis 8 days after botox (dysport), without any previous indication or symptoms prior?

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