The botulinum toxin contained in Botox injections causes paralysis. But properly administered, these injections can prevent the muscles that cause age lines like forehead wrinkles, crow’s feet, and frown lines from contracting. If those muscles can’t contract, the age lines are less apparent, giving the face a smoother, more youthful look.

Occasionally, when the toxin is injected, it can travel to unintended areas. In some cases, you could experience a droopy eyelid after Botox.

When Botox migrates to one or both of two specific areas, Botox injections can result in a droopy eyelid — also called ptosis.

These two areas are the forehead and between the eyes.

Forehead

Botox is injected into the forehead to minimize forehead wrinkles. The injection prevents the frontalis muscle that raises the eyebrows from contracting, which also prevents horizontal frown lines from forming. In most cases, this gives the appearance of a smooth forehead.

Occasionally, it can cause the brow to descend, which crowds the upper eyelids and makes them appear to be drooping.

Between the eyes

Botox can be injected between the eyebrows or just over the brow to minimize the vertical frown lines that make “11 lines” just above the nose. Occasionally, some of the Botox seeps into the upper eyelid and paralyzes the levator palpebrae — the muscle that holds the upper eyelid up. If this muscle is paralyzed, the upper eyelid will droop.

Of the 15.7 million minimally invasive cosmetic procedures performed in 2107, 7.23 million of them were Botox injections (botulinum toxin type A).

It takes about one week after a Botox injection for the toxin to bind to nerve receptors. This prevents the nerves from reaching the muscle. As a result, your muscle will be paralyzed for three or four months, preventing wrinkles from forming.

Performing Botox injections can be tricky because it’s important to make sure the toxin only affects the injected muscles.

Because people have varying facial muscle movements, the doctor has to make educated decisions about:

  • where to inject the Botox
  • the proper depth to avoid surface migration of the toxin

A slight miscalculation, like making the injection too low in the forehead muscle, can cause eyelid drooping after Botox.

Botox is a temporary treatment. The treatment can last three to seven months, but the droopy eyelids will typically go away in four to six weeks.

Apart from waiting, a couple of treatments might alleviate the problem:

  • eyedrops, such as apraclonidine (Iopidine), which can help if the eyelids are drooping, not the brows
  • more Botox, which can counteract relaxed eyebrow muscles if injected in the right place

If you feel that Botox injections are a good fit for your needs, make sure that you have chosen a reputable and experienced doctor. This is the best way to avoid problems like droopy eyelids.

If you end up with droopy eyelids after Botox — which is rare — you might have to wait for the Botox to wear off (about six weeks) for them to return to normal. Or you may consider returning to your doctor for additional treatment to correct the problem.