Could I get a droopy eye?

I had Botox on 3/25 in my forehead by a new doctor. My frown lines are totally frozen today 3/28 and I have a heaviness in one eye. Will this heaviness turn into a droopy eye? When am I in the clear for a droopy eye? The doctor broke a blood vessel in my forehead and I have a large bruise/knot so I am scared something else is going to go wrong. I also used a higher dose and the results seem faster than before.

Doctor Answers 5

Bruising and eye heaviness 3 days after Botox...

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I would recommend following-up with your injecting physician in one week to discuss any persistent symptoms or complaints from the Botox injection to see how they can be remedied. 

In the mean time, I have the following to offer... 

In terms of the "bruising/knot", that will likely resolve in a week.  Have your physician re-examine the area when you follow up.

In terms of the eye "heaviness", you will have to wait approximately 7-10 days for the full effects of the Botox to set in.  At that point your physician can assess if you truly have any heaviness -- whether that is a droopy eye-LID or a droopy eye-BROW.  The distinction is important because each has a different treatment that may help.  That way, you may not have to wait for the full duration of the Botox (3-4 months) to be over before the eye "heaviness" (if present) is improved...

A droopy eye-BROW from Botox can sometimes be improved with Botox injected into the outside part of the eye (the lateral aspect of the orbicularis oculi) to generate a bit of a brow lift in that area -- by paralyzing the orbicularis muscle that normally acts to depress the brow, you may get a slight compensatory brow lift with more Botox...

A droopy eye-LID due to Botox can be treated with Apraclonidine eye-drops which can provide a small (2mm) improvement. Be sure your prescribing physician discusses all 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...

In the future, I would recommend that you seek 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, and the patient variability therein. 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 since I commonly dissect under the skin and see the actual muscles themselves. For me, this helps guide where to inject and where not to. However, with that said, I know many Dermatologists who know the anatomy well despite not operating in that area, and get great results.

Good luck.

Botox and Frown Lines

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Botox is great for smoothing out frown lines.  If the doctor used a higher dosage then it is normal that you seem "more frozen" than before.  It takes two weeks to see the full effects from Botox but generally within a few days you will know if you develop a "droop".  The heaviness that you are describing sounds like you may have had too much Botox or Botox injected too low.  Please let me know what happens. 

Droopy eyelid after botox?

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Thank you for your question. Botox will have full effect by 7-10 days. If you do not have a droopy eyelid by then, it would be unusual to get one. Often excess upper lid skin gets confused for a droopy eyelid. If Botox migrates and paralyzes the upper lid lifting muscle, the eyelid sags and covers the pupil a bit. This is the droopy eyelid. If the forehead is paralyzed, the muscle can't lift the brow and upper eyelid skin, this can cause excess baggy skin that can touch the lashes. People become aware of this sensation and think their lid is sagging. It is not truly the lid itself, but the skin above it. The pupil is not blocked by the lid and thus is not truly the droopy upper eyelid. Hope this helps to clarify.

Brian C. Reuben, MD
Salt Lake City Plastic Surgeon
5.0 out of 5 stars 37 reviews

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Botox and droopy eye

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  • Botox can cause bruising. It subsides.
  • Only time will tell if the upper lid heaviness will lead to a droopy lid.
  • In another 48 hours, if you do not have a droopy lid, you are unlikely to get one.
  • Injections of Botox should be at least a half inch above the brow. to reduce this risk.

Droopy eye from Botox

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Although a droopy lid can occur from Botox, most often what happens is a few weeks of a heavy brow that can make the eyelid feel droopy. Effects of Botox start to show in 3-5 days and hit full effect in 7-10. A heavy brow will resolve itself quickly without the need for intervention. A droopy lid may require a special eye drop for a few weeks. The bruise/knot can happen to the most experienced injectors and doesn't pose any long term issue. Next time remind the doc that your brow felt heavy so he can inject a little higher and with less Botox to prevent this from occurring. 

Lee P. Laris, DO
Phoenix Dermatologist
4.8 out of 5 stars 16 reviews

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.