Eye drooping after Botox,

The patterns I noticed during 19 minutes of consultation over two months

I'll start with the conclusion.

Eye drooping after Botox is

"not because the Botox was done wrong,"

but one of two causes.

I'll explain why in this article.

Eye drooping is not all the same

When I listen to people who come in saying their eyes drooped after Botox,

it turns out two things are actually mixed together.

One is the feeling that the brows have dropped heavily,

the other is when the upper eyelid itself hangs down and covers the eye.

The tricky part is that, from the client's perspective,

both are described as "my eyes drooped."

Medically, they're completely different.

The first is brow ptosis,

the second is true eyelid ptosis.

The causes are different, the recovery path is different,

and the treatment is different.

Why is it that even with the same Botox

some people droop while others are fine?

Key point of this article

There are exactly two reasons for eye drooping after Botox,

how to tell frontalis overparalysis vs levator palpebrae infiltration

Cases like this are really common, so I'm writing them down separately.

Last month, a 34-year-old woman came in,

"It's been a week since I got Botox between my eyebrows,

and one eye feels so heavy I can't open it," she said.

I lightly lifted her brows with my hand in front of the mirror,

and even then the upper eyelid was covering half the pupil.

This isn't brow drooping, but

it's a case where the levator palpebrae (the muscle that lifts the eyelid)

has been infiltrated by toxin.

Here's the mechanism.

If the glabellar injection site is too close to the supraorbital rim (brow bone)

within 1 cm,

the toxin travels along the orbital septum

and reaches the levator palpebrae.

Conversely, if too much is injected too widely into the frontalis,

the entire forehead stops moving,

and the force that was supporting the brows gives out.

That's brow ptosis,

and many people describe it as "my eyes got smaller."

This 34-year-old patient had levator infiltration,

and fortunately it started to wear off from week 3,

returning almost to normal by around 6 weeks.

As an emergency measure, with Iopidine (apraclonidine) eye drops

we stimulate the Müller muscle to provide about 1-2 mm of

immediate support.

Dr. Wi Young-jin's Key Summary

Eye drooping after Botox is either "the brows having dropped due to frontalis overparalysis

or

"toxin infiltrating the levator palpebrae

causing the eyelid itself to cover the eye,"

and the first step is telling these two apart.

If lifting the brows by hand opens up the field of vision, it's the former,

if the eyelid still covers it, it's the latter.

Take a look at which type you have

So which category do I fall into?

Here's a quick table.

The approach differs by type,

for the brow-drooping type, time is really the medicine.

A small additional injection into part of the frontalis

is often enough to balance the left and right sides.

The eyelid-drooping type is different.

Once toxin has entered the levator palpebrae,

there's no way to forcibly break it down,

so eye drops that stimulate the Müller muscle

are the best support during the recovery period.

But this isn't a perfect solution.

The eye drops are temporary too,

and in the end you have to wait for the toxin to break down naturally.

Still, it helps reduce discomfort in daily life

during that period.

Three things clients really ask a lot,

I'll answer honestly

Q1. This isn't permanent, right?

Will it really go back to normal?

A. Honestly,

I get this question three or four times a week.

Bottom line: it's not permanent.

Botox temporarily blocks acetylcholine release

from nerve endings.

As new nerve endings grow,

the original function returns.

It varies by case, though,

but most people recover almost completely within 4-8 weeks,

and in rare cases it can take up to 12 weeks.

You don't need to worry, "What if it's like this forever?"

And this is another very common question.

Q2. Is there a separate treatment to reverse the drooping?

How much does it cost?

A. This is a bit tricky,

"There isn't yet a true 'Botox reversal' medication."

There are places that advertise it that way,

but strictly speaking, it's an adjunct therapy.

I usually use two things.

One is 0.5% Iopidine eye drops,

which stimulate the Müller muscle

and immediately lift the eyelid by about 1-2 mm.

It costs about 30,000-50,000 won per bottle and requires a prescription.

The other is balancing Botox on the opposite side,

where a small amount is added not to the drooping side but to the normal side

to even things out.

We decide based on the case.

Lastly, let me point out this part too.

Q3. Can I get Botox again next time?

I'm scared it'll droop again

A. This is something many people misunderstand.

Just because it drooped once doesn't mean it will droop again.

In fact, if we know which area and at what depth caused the drooping,

and we have that documented,

we can move that point more than 1 cm upward next time

or adjust the dose to avoid it.

Among our patients, some experienced eyelid drooping once

and from the next session onward have been keeping things neat for 6 months

without any issues.

Don't give up; bring your previous treatment information

and get a consultation.

I recommend discussing everything thoroughly before deciding on the procedure.

In the next post, I'll cover 'the first two weeks after Botox,

the changes we really see in the clinic.'

Why people feel the effects at different times,

and which people wear off early

and which ones last longer

I'll show you with cases.

That was Wi Young-jin.

Also read

• Can cheekbone Botox make the corners of your mouth turn? [Needle replacement needed]

• If you just got Botox, the effects won't show right away! It varies by area

• Looking only for the cheapest masseter Botox? Why that number is a trap

Frequently asked questions

Q. This isn’t permanent, right? It really comes back again?

A. In short, it isn’t permanent. Most people recover almost completely within 4 to 8 weeks, though in rare cases it can take up to 12 weeks.

Q. Is there a separate treatment to tighten sagging? How much does it cost?

A. There isn’t anything like a “Botox-reversing medicine” yet.

Q. Can I get Botox again next time? I'm afraid it might sag again.

A. Just because it sagged once doesn’t mean it will sag again next time. Don’t give up—just bring the details of your previous procedure and get a consultation.

Q. How can you tell if sagging eyes after Botox are due to a brow issue or an eyelid issue?

A. Try gently lifting your eyebrows with your hands. If your field of vision clears up, it is a drooping eyebrow type caused by frontalis muscle hyperparalysis. If your eyelids still cover your eyes even when you lift them, it is a ptosis type caused by levator muscle penetration. Both types typically recover within 4 to 8 weeks.