Drooping Eyelid (Ptosis) After Botox: Why Does It Occur, How Does It Pass? A Comprehensive Guide

The aim of a botox injection is to temporarily block the movement of the target muscle that causes the wrinkle. However, if the medication leaves the boundaries of the muscle into which it is injected and seeps into the neighbouring muscle tissues (diffusion), it leads to the relaxation of the off-target muscles too. The main muscle that lifts the eyelid upward and keeps it open is called the levator palpebrae superioris. If the botox toxin reaches this muscle, the muscle cannot fully perform its function and the upper eyelid droops downward. This situation is sometimes only in the form of a mild asymmetry, but at other times can reach a level that causes the eye to half close and the field of vision to be restricted.

Drooping of the eyelid is related, rather than to the poor quality of the botox medication itself, almost entirely to the application technique, a lack of anatomical knowledge or the patient not following the post-procedure rules. Op. Dr. Ayşe Öznur Akidil lists the main factors that pave the way for this complication as follows:

• Injection at the Wrong Anatomical Point: While correcting the vertical/horizontal lines in the between-brow (glabella) or forehead area, injecting very close to the eye socket (orbital) boundary increases the risk of the medication seeping directly into the eyelid muscle.

• High Dosing: Every patient's muscle strength and mimic structure are different. Applying high-dose botox to everyone through standard templates causes the medication to overflow into the surrounding tissues (diffusion).

• Wrong Injection Depth and Angle: Giving the medication not into the muscle but into very superficial or very deep tissues, at the wrong angle, can lead to uncontrolled spread of the medication.

• The Patient Violating the Post-Procedure Rules: Rubbing the injection areas hard right after the procedure, applying circular pressure while washing the face or bending the head forward can push the medication by hand toward the eyelid muscle.

Drooping of the eyelid after botox is not a situation that emerges instantly as soon as the procedure ends. The binding of the toxin to the muscle ends and its seepage into the neighbouring muscle takes time. It usually begins with a feeling of heaviness in the eyelid between the 3rd and 7th days after the non-surgical procedure, and on the 10th to 14th day, when the effect of the botox reaches its maximum, the ptosis also takes its most prominent form.

The point patients fear most is that this situation is permanent. However, it should be known that botox is a temporary toxin. This process affecting the eyelid corrects itself completely as the medication is slowly metabolised by the body. In most patients the drooping eyelid disappears completely within 4 to 6 weeks, without waiting for the total 4-6-month life of the botox, and the lid regains its old symmetry.

There is no "antidote" or dissolving enzyme that would ensure the botox is withdrawn directly from the injected tissue or instantly neutralised. However, to speed up the process and increase the patient's aesthetic/functional comfort, some medical methods applied under the supervision of Op. Dr. Ayşe Öznur Akidil:

• One of the most effective medical agents in the treatment of this condition is special prescription eye drops. These drops stimulate an alternative muscle (the Müller muscle) that lifts the eyelid and is not affected by botox. Thanks to the contraction of the Müller muscle, the drooping upper eyelid rises about 1 to 2 millimetres. This temporary relief allows the patient to open their eye more comfortably and camouflages the asymmetry as long as the effect of the drop continues.

• Warm compresses applied in a controlled way during the day to the injected brow and forehead area, or light facial exercises aimed at working the muscles in that area, increase local blood circulation. The acceleration of blood circulation can help the blocking effect of the botox on the muscle resolve a little earlier than normal.

The most certain way to protect against annoying complications such as ptosis is to have the procedure done at a professional medical clinic. When looking for aesthetic solutions in İzmir, one should stay away from what are called unlicensed salons where non-physicians work.

• For the first 4 hours after the injection, one must absolutely not lie on the back and the head must not be bent forward (movements such as tying shoes, bending forward to clean, etc. should be avoided).

• For the first 24 hours the face should not be rubbed, no massage should be done and no pressure should be applied with make-up brushes.

• For the first 3 days, high-heat areas such as the Turkish bath, sauna and solarium and heavy sports activities should be avoided.

Facial aesthetic applications require surgical anatomy knowledge too serious to be reduced to simplicity. Op. Dr. Ayşe Öznur Akidil, at her modern clinic in İzmir Bayraklı, maps each patient's muscle strength, asymmetries and mimic structure individually. Instead of standard doses, by doing millimetric dosing according to the patient's need, she keeps the risk of complications at a minimum. In our clinic only the highest-quality original products with international safety approvals (FDA) are used.

Drooping of the eyelid after botox, although a temporarily annoying process for patients, is a completely reversible condition. What matters is not to panic during this process, to stay in communication with your doctor and to benefit from the drop treatments that will ease the process. Always entrusting your face and your gaze to a surgeon's vision and experience is the safest way to remove such risks from your life.

Op. Dr. Ayşe Öznur Akidil is ready to welcome you at her clinic for safe, natural and flawless aesthetic touches in İzmir. To achieve a fresh and young appearance free of the concerns on your mind, you can contact us and plan your appointment.