Too high a dose or incorrect placement can over-relax the frontalis muscle, causing the eyebrow to lower, or droop. In addition to the distressing aesthetic problem, patients report that their eyebrows feel “heavy.” Eyebrow droop is sometimes accompanied by the upper eyelids also becoming very heavy and hooded.
Sometimes, we can help the eyebrow to lift by giving Botox to the muscle that pulls it down, Orbicularis Oculii. This is the same muscle that wraps around the eye to close it. Injecting it laterally in very specific points can help lift the eyebrow without affecting the movement of the eyelids.
We can also inject small amounts of Botox above the lateral aspect of the eyebrows to lift droopy brows and open up the eyes. By strategically injecting toxin into key areas of the glabella and brow areas, the forehead will be raised, and you will look more relaxed with a more youthful appearance.
Specifically, injections on the forehead or between the eyes may spread into the eyebrows and cause the brow to lower, causing a droopy eyelid. In most cases, droopy eyelid occurs between one and three weeks after treatment, and patients typically experience this adverse effect for just a few weeks.
The appearance of vertical lines after Botox is due to its unique utilization and weaving. The corrugator muscle is responsible for creating the inter-brow number “11” creases. Once these muscles are crippled, the brain recruits the orbicularis oculi to produce the same expression.
When Botox is applied to problem areas around the eyebrows, the muscles relax and the skin on top of them becomes smoother. The muscles around the eyebrows are pulled upwards, elevating the eyebrows and making a patient's eyes appear more open. Patients are thrilled to find they look alert, peppy, and rested.
The levator is the muscle that is responsible for maintaining the eyelids in their normal position. However, in some instances, Botox migrates from the injected treatment area and ends up in the levator muscle. When this occurs, it causes drooping eyelids or droopy eyebrow.
You'll notice an improvement in two to three days, with most patients seeing full results after the botox injection in seven to 10 days. The muscles above the eyelid and eye area, now weakened by the injection, smooth away grooves and frown lines.
Blake recommends starting on either side of the face just under the orbital rim as this is the key injection site for a brow lift. As with any aesthetic medical procedure, in order to perform a brow lift, it is necessary to understand the intricate anatomy of the muscles below the skin to achieve the desired outcome.
According to Dr Gavin Chan, one of the most important things practitioners can do is to, “inject the lateral tail of the corrugator which is the muscle which causes the bunching (6.35) of the frown. Superficially injecting the lateral tail of the frown (corrugator) muscle can help avoid ptosis”.
Actual cases of droopy upper eyelid after Botox injections are rare. Most issues of upper eyelid heaviness after Botox injections in the forehead area are due to over paralysis of the forehead muscle, causing drooping of the eyebrow.
Eyelids may droop after a Botox procedure if the provider administers too much Botox or injects it in the wrong location. In rare cases, the neurotoxin spreads to the wrong muscle causing eyelid drooping when the patient doesn't follow the provider's aftercare instructions, such as lying down or bending over.
Lid and Brow Ptosis Treatment
Lid and brow ptosis from Botox usually appears a few days to a week after being injected. Usually, it gets better after three to four weeks.
One common treatment is an α2-adrenergic agonist ophthalmic eye drop, 0.5% apraclonidine. Another selective α2-adrenergic agent, brimonidine eye drop, is used as an alternative to apraclonidine to treat eyelid ptosis.
Spock brows happen when Botox is injected only at the central part of the upper forehead, leaving the sides untouched. When the central forehead is weakened and the outer sides remain active, it causes the central brow to drop and the outer brow to appear like it's lifted too high. The result: Spock brows.
If the Botox is placed too low or if it migrates down, the Botox can affect the lower part of the muscle and cause a droopy eyebrow. Sometimes when your eyebrow goes down, it can make your upper eyelid heavy too, making it look like droopy eyelids.
Unfortunately, eyebrow droop is also a potential side effect of Botox treatments. This condition tends to appear a few days to a week after the procedure, as the treatment takes effect. Typically, this problem is correctable. Unfortunately, eyebrow droop is also a potential side effect of Botox.
Botox works by weakening muscles. If you weaken the upper forehead (frontalis) muscles, you will not get a brow lift, your brow will drop. The injector actually must weaken the muscles that pull down the brow.
Completing the Procedure
For most patients, between 4-8 units is common for the outer brow and 20-30 units on average for the area between the eyebrows. Additional units may be used if there are other areas of your face you want to focus on.
The Botox Treatment for Hooded Eyelids
Treating hooded eyelids with Botox is a relatively simple process. The treatment involves injecting Botox into your lower forehead and the outer ends of your eyebrows. When injected, it will paralyze the muscle by effectively preventing nerve receptors that prompt muscle movement.
This can happen due to aging and loss of connective tissue, or from chronic rubbing. Other causes include congenital diseases, long term hard contact lens use, or weakness of the levator muscle.
While brow lift can achieve more dramatic changes, Botox is preferable for making slighter, more subtle improvements. The timeline for each procedure is also much different. Botox results last about three to four months in this area, whereas brow lift changes are generally visible for a decade.
When someone is receiving too much treatment with anti-wrinkle injections, the skin can become extremely smooth and the light bounces off in a uniform way. So, the skin appears shiny, which is why it can look 'frozen'.