Droopy Eye After Botox: Causes, Prevention, and Treatment

Botox injections, a staple in cosmetic treatments, have become synonymous with the pursuit of youth and beauty. Renowned for smoothing out forehead wrinkles and crow’s feet, these injections use a neurotoxin, botulinum toxin, to temporarily paralyze facial muscles. However, despite its popularity, Botox comes with its share of side effects, including the possibility of droopy eyelids (eyelid ptosis) or a droopy eyebrow (brow ptosis). This article delves into the causes, prevention, and treatment options for these unintended consequences of cosmetic injections.

Causes of Droopy Eyelids After Botox

How Botox Affects Eye Muscles

Botox works by blocking the receptors in muscle movements, preventing them from contracting, which leads to a reduction in fine lines and wrinkles. However, when injected near the upper eyelid, it can sometimes affect the levator palpebrae superioris – the muscle responsible for lifting the eyelid. If Botox impacts this levator muscle or the frontalis muscle (forehead area), it can result in eyelid drooping.

Blepharoptosis, or droopy eyelid, is often attributed to the spreading of botulinum toxin through the fascia of the orbital septum to the levator palpebrae superioris muscle in the upper eyelid, often due to the application of botulinum toxin outside the safe zone or marked dispersion of the toxin from excessive manipulation of the region1. The levator palpebrae superioris muscle is particularly susceptible to low doses of botulinum toxin given its comparatively limited number of motor endplates.

Identifying Risks

The use of botulinum toxin formulations, such as Dysport, can indeed lead to droopy eyelids (blepharoptosis) as a side effect. This is due to the spread of the neurotoxin to unintended muscles, which can cause temporary paralysis or weakness. The incidence of this side effect varies, but it is more common among inexperienced injectors. For instance, a study conducted by Allergan estimated the incidence of botulinum toxin-induced blepharoptosis to be 5.4% among inexperienced injectors and less than 1% among experienced injectors.

The spread of the toxin and the risk of side effects like blepharoptosis can be influenced by several factors. These include the specific formulation of the botulinum toxin used, the injection technique, and the skill of the injector. For instance, different formulations of botulinum toxin are not interchangeable due to variations in their units, chemical properties, biological activities, and weight. The injection technique, including factors like dilution, volume, and dose, can also affect the spread of the toxin and the risk of side effects.

Moreover, the skill and experience of the injector play a significant role in the outcome. Experienced injectors are less likely to cause side effects like blepharoptosis. They are also more likely to understand the clinical issues of potency, conversion ratio, and safety issues related to the spread of the toxin and its immunogenicity.

Symptoms and Diagnosis of Droopy Eye

Eyelid ptosis, also known as droopy eyelid, is a condition where the upper eyelid of one or both eyes droops over the eye. The degree of drooping varies from person to person and can range from barely noticeable to severe, where the eyelid covers the pupil entirely, potentially limiting or even completely blocking normal vision.

The most common symptoms of eyelid ptosis include:

  • A feeling of heaviness in the upper eyelid
  • The eyelid appearing to droop
  • Difficulty closing the eye completely
  • Double vision
  • Eye fatigue
  • Irritation
  • Tilting of the head to see better7

In some cases, patients may need to tilt their heads back into a chin-up position, lift their eyelid with a finger, or raise their eyebrows to see properly. Continuous activation of the forehead and scalp muscles to compensate for the drooping eyelid can lead to tension headaches and eyestrain.

Preventing Droopy Eye in Botox Treatments

To mitigate risks, it’s imperative to choose a certified professional. These professionals are well-versed in facial anatomy and understand how to target the right muscles without impacting the levator palpebrae or frontalis muscle.

Discussing your medical history, especially any past experiences with Botox or dermal filler treatments, can guide your practitioner in choosing the safest treatment options. Understanding the potential effects of Botox on your specific facial expressions and muscle movements is a key part of this conversation.

Effective Treatments for Droopy Eye

Immediate Response and Care

If you notice symptoms of eyelid ptosis, getting in touch with your practitioner promptly is critical. Sometimes, simple measures like massaging the affected area can help, but this should always be done under professional guidance.

Clinical Treatments and Recovery

Various clinical treatments are available for managing droopy eyelids, particularly those resulting from Botox injections. These include:

  • Use of Eye Drops: Eye drops like apraclonidine can stimulate the Müller’s muscle, providing temporary relief from the drooping eyelid1. Another FDA-approved prescription eye drop, Upneeq, can temporarily improve droopy eyelids with a single daily dose. However, it’s important to note that Upneeq is not a substitute for eyelid lift surgery and is best suited for temporary use.
  • Additional Botox Injections: In more persistent cases, additional Botox injections in the opposing muscle group can help counteract the effects of the initial treatment.
  • Waiting for Botox to Wear Off: Since the effects of Botox are temporary, waiting for them to wear off is another common approach. Most cases resolve as the Botox wears off, typically within a few weeks to months1.

It’s important to remember that recovery times can vary, and the most effective treatment approach will depend on the individual’s specific circumstances and the underlying cause of the droopy eyelid.


While Botox treatment offers a path to facial rejuvenation, it’s important to be aware of the potential side effects, including droopy eyelids and eyebrows. By choosing qualified practitioners and understanding the risks involved, patients can make informed decisions about their cosmetic procedures.


Does droopy eyebrow from Botox go away?

Yes, droopy eyebrow from Botox is typically a temporary condition. The effects gradually wear off as the neurotoxin’s influence diminishes, usually over a few weeks to months.

How do you reverse a droopy eyelid?

A droopy eyelid from Botox can be managed with certain eye drops like apraclonidine or Upneeq, which help elevate the eyelid temporarily. In some cases, additional Botox injections in the opposing muscle group may be considered.

How do you prevent droopy eyes from Botox?

To prevent droopy eyes from Botox, it’s crucial to choose a skilled and experienced injector who understands the intricacies of facial anatomy, particularly the muscles around the eyes. Accurate injection technique and proper placement of Botox are key to avoiding this side effect. Additionally, informing your injector about any previous experiences with Botox or other neurotoxins can help tailor the treatment to your specific needs.

What Neurotoxin is most prone to Droopy Eye?

The risk of droopy eye can vary depending on the specific neurotoxin used in the Botox formulation. Some studies suggest that certain types of botulinum toxins, possibly those with a higher tendency to spread from the injection site, might have a higher risk of causing eyelid ptosis. However, the skill of the injector and the specific injection technique are also significant factors in this outcome. It’s important to discuss these aspects with your healthcare provider to understand the risks associated with different neurotoxin formulations.

When should I consult a plastic surgeon or dermatologist for Botox-related complications?

If you experience persistent or severe complications from Botox injections, such as prolonged droopy eyelids or eyebrows, it’s advisable to consult a plastic surgeon or a dermatologist. These specialists have in-depth knowledge of facial anatomy and are equipped to assess the extent of the issue and recommend appropriate treatment options, which may include corrective procedures like blepharoplasty or a brow lift. Early consultation is crucial for effective management and to explore all potential treatment avenues.