Botox and droopy eyelids. What happened?

Botox has few complications.  The most common are bruising and “eyelid droop.” 

There are two reasons for eyelid droop.

• When injecting right above the eyebrow the botox could affect the levator muscle.  In English, your eyelid functions like a windowshade, and your levator is the muscle which lifts up the windowshade.  If botox diffuses into the muscle, the levator weakens, so you can’t lift your windowshade as high.  This is not common.  If it does happen there are eyedrops which help correct it, and the effect wears off.
• The other reason is the more common one, and it stems from injecting botox into the forehead.  To get rid of forehead wrinkles we purposefully inject botox into the forehead muscle (the “frontalis” for you anatomy buffs).  In this case the forehead muscle is weakened and the wrinkles soften or go away, which is our goal with the botox.                                                                                                                                                                                             The issue is you form the wrinkles on your forehead for a reason.  As you age, your eyebrows fall. (yes, yes. this gravity thing sucks.)  As your eyebrows fall as you age, your forehead needs to lift harder and higher to get your eyelid out of the way so you can see.  This makes the forehead wrinkles worse.  And more of them.  And deeper.  As your forehead falls, you will get fullness in your upper eyelid.  Unfortunately this process continues as you age, so your fullness gets worse and your wrinkles deepen.

Eventually you can’t correct forehead wrinkles with botox, because it drops the brow and makes you look “droopy,” “tired,” or “older.”  At that point, you need to either 1. deal with having forehead wrinkles. 2. fix the problem- which involves a browlift, upper eyelid surgery “blepharoplasty,” or combo or 3. get bangs.

When I inject botox,

• I always use fresh botox, and
• I mark exactly how much and where I inject. 

As your wrinkles deepen and your brow falls, I am not able to correct you fully because your brow would drop too much and give you that old, tired appearance.  Sometimes I can cheat and inject less botox, higher, etc to soften the forehead wrinkles without blocking the forehead entirely.  This helps put off when we need to do a surgery.

But eventually as you age, your needs change.  At some point botox cannot “fix” things. Most people need to do surgery around the eye to lift the brow or remove the excess upper lid skin or both.  This surgery tends to happen anywhere from late 30s  to the 50s.  The surgery will correct the problem by lifting the brow and/ or remove the excess skin. 

What worked for you in the past may stop working.  Until then though… keep the botox coming.