Eyelid ptosis means the upper eyelid sits lower than normal. After cosmetic botulinum toxin treatment, this may occur if toxin unintentionally affects the levator palpebrae superioris, the principal muscle responsible for elevating the upper eyelid.
Patients may describe a droopy eyelid, one eye looking smaller, difficulty opening one eye fully, a heavy upper eyelid or new asymmetry.
Eyelid ptosis means the upper eyelid margin itself drops. Heavy brow or brow ptosis means the eyebrow sits lower, making the lid look heavier. A patient can also have naturally hooded lids or pre-existing asymmetry.
If toxin affects the levator muscle, temporary weakness can develop. Risk is influenced by treatment area, dose, placement, anatomy, diffusion and pre-existing eyelid or brow asymmetry.
It may not appear immediately because Botox effects develop progressively. Botox-related ptosis is generally expected to be temporary and improve as the unintended muscular effect diminishes. Persistent or atypical ptosis requires further medical evaluation.
There is no medication that instantly removes the toxin from the affected muscle. Selected prescription eye drops may temporarily improve eyelid elevation in appropriate patients, but they do not reverse the Botox itself.
Botox cannot restore strength to the levator muscle. Additional toxin may sometimes be used elsewhere to improve overall brow symmetry, but it does not reverse true eyelid ptosis.
Assessment may include upper-eyelid position, eyebrow position, pupil visibility, eye movement, forehead movement, baseline photographs, previous asymmetry, timing of Botox, injection areas and other neurological symptoms.
Seek more urgent assessment if drooping is accompanied by sudden significant visual disturbance, double vision, severe headache, weakness, difficulty speaking, swallowing or breathing, or other acute neurological symptoms.
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