Transient eyelid droop is the most significant side effect of Botox injections administered to the forehead for the removal of wrinkles and creases. It occurs in up to 3 percent of injections. Drooping of one or both eyelids appears after Botox is injected into the muscles between or above your eyebrows. The drooping effect may not appear until up to two weeks after injection and can last for months afterward.
Facts
Botox is made from the Botulinum neurotoxin, which is produced by the bacterium Clostridium botulinum. Botox works by paralyzing muscles through blocking the neurotransmitter that causes contraction. The paralyzing effect of Botulinum toxin has been used clinically to treat neuromuscular disorders such as facial spasms, multiple sclerosis and vocal cord dysfunction. In the 1980s, the isolated Botulinum neurotoxin A was used to treat facial spasms. That is when the cosmetic benefits were first recognized. Botox relaxes areas by interrupting contraction of the underlying facial muscle, causing a smoothing effect. It is the leading cosmetic procedure in the world today.
Concerns
In the cosmetic application of Botox, some side effects have been observed, such as the development of upper eyelid drooping after Botox injections to the forehead. The eyelid drooping can appear in one or both upper eyelids and may appear three to twelve days after injection. When the droop occurs on only one side, it raises the concern of facial nerve damage or palsy. If you already have droopy upper eyelids, the Botox may worsen your condition. Because the side effect is rare, you may not have been informed before the procedure by your clinician.
Pathway
There are many small muscles and nerves that control the activity of the eyes, the eyelids and the movement of the eyebrows. Typically upper eyelid droop occurs after injection of Botox between the eyebrows or directly above them. Some of the Botox then "leaks" down into the levator palpebrea superioris muscle. The action of the levator muscle is to elevate your upper eyelid. The Botox causes prolonged relaxation of the levator muscle and you are unable to raise your eyelid and sometimes the eyebrow too. In some cases, Botox injections to the forehead have led to a numb sensation as far down the face as the upper lip.
Solutions
There are eye drops that can stimulate the upper eyelid muscle to contract to counteract the drooping. These eye drops include Alphagan, Lopidine, Ipratropium and Phenylephrine. They are prescribed as 1 to 2 drops three times daily until the condition subsides. Some sufferers have tried non-medical approaches such as a daily facial tightening mask, while others have found a daily steam sauna and massaging the eyebrow to be helpful. Beyond the use of eye drops and the non-medical therapies, there is little else you can do except wait.
Considerations
You should realize that the effect of Botox on each person depends on the dosage used, the experience of the clinician and the sensitivity of the individual. The eye drops indicated for treatment of upper eyelid droop must be prescribed by your physician and you may not be able to use them if you have glaucoma, are taking MAO inhibitors or have other underlying conditions. Botox injections for cosmetic applications are FDA approved and regulated. If you get a Botox injection, be sure the doctor or nurse is certified for it and has plenty of experience.
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