Drooping Eyelid After Botox: What It Is and What Can Be Done
⚠️ Seek urgent care if you notice these symptoms
If your drooping eyelid is accompanied by double vision, difficulty swallowing, trouble breathing, muscle weakness spreading beyond your face, or any symptoms that feel serious or are getting rapidly worse, seek emergency medical attention right away. These could indicate a rare but serious spread of the toxin beyond the injection area.
Short answer
A drooping eyelid after Botox is called blepharoptosis (eyelid ptosis). It happens when the toxin spreads to the muscle that lifts your eyelid. The good news is it almost always resolves on its own within about 3 months, and there are treatments that can help in the meantime.
What the research shows
Eyelid drooping after Botox occurs when the toxin spreads from the injection site and weakens the levator palpebrae superioris, the muscle responsible for lifting the upper eyelid. [2] It typically appears 3 to 14 days after treatment and almost always resolves on its own once the toxin wears off, usually within about 3 months. [5] It is more common with less experienced injectors, with rates ranging from 2.5% to 5.4% in that group compared to roughly 0.5% to 1% with experienced injectors. [5]
Several treatments have been shown to help while you wait for recovery. The most studied options include:
- Prescription eye drops such as oxymetazoline HCl (Upneeq) or apraclonidine, which stimulate a different muscle in the eyelid to temporarily help lift it. [2][3]
- Pretarsal Botox injections, a technique where a small amount of Botox is placed in a specific part of the eyelid to reduce the downward pull of the orbicularis muscle, partially reversing the droop. [3][4]
- A combination of both approaches has been used successfully in small case series of patients with severe ptosis (drooping more than 3 mm). [3]
What this means for you
If your eyelid has started drooping after a Botox treatment, contact the provider who treated you as soon as possible. Do not try to manage this on your own without medical guidance. Your provider can assess how severe the ptosis is and recommend the most appropriate next step, whether that is watchful waiting, prescription eye drops, or a specialist referral. [5]
The most important thing to know is that this is a temporary side effect. Even without any treatment, the drooping will resolve as the Botox effect fades. Most cases recover fully within 3 months. [2][5]
Caveats
The research available on treatments for Botox-induced eyelid ptosis consists mainly of small case reports and case series, not large controlled trials. [1][3][4] This means we have promising evidence that certain treatments help, but we do not yet have large-scale proof of which approach works best or for whom. Treatment should always be guided by a qualified medical professional who can assess your specific situation. [5]
What to ask your provider
- How severe is my eyelid drooping, and does it require treatment or just monitoring?
- Am I a candidate for oxymetazoline (Upneeq) eye drops to temporarily lift the lid?
- Should I see an oculoplastic surgeon or ophthalmologist for evaluation?
- How long do you expect this to last based on where and how much Botox was injected?