Ptosis is the abnormal lowering or drooping of an anatomical area. 1. congenital muscle disorders, 2. injury or trauma, 3. age, and 4. nerve and connection problems around the eyes can all cause ptosis in the eyelids or brow droop. Ptosis can also be caused by a side effect of Botox treatment.
Botulinum toxin complications of eyelid or brow ptosis can cause a displeasing facial aesthetic in the eye region. They can also cause functional issues such as reduced visual field, eye strain, or ache.
First and foremost, photographic evidence should always be used to establish the baseline appearance. Discuss pre-existing asymmetry and modify treatment plans if ptosis is visible before treatment.
Eyelid ptosis
This complication is most common in clients who want to treat frown lines in the glabella. The injected toxin in this area can occasionally migrate and inactivate the levator palpebrae muscle. When treating the frown area, keep lateral corrugator injections superficial and pointing away from the orbit. It is also beneficial to isolate the muscle by picking it up and injecting directly into the skin.
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.
If there is a functional deficit, it can be treated topically with Apraclonidine 0.5% if not contraindicated. This is an off-label indication that provides a brief 1-3mm lift of the eyelid via its alpha2-adrenergic agonist action on Muller’s muscle.
Eyebrow ptosis:
Brow ptosis is more common than lid ptosis. It happens when Botox is injected into the forehead to prevent the frontalis muscle from contracting. Brow ptosis occurs when either 1. an excessively high dose is administered or 2. the drug is injected too deeply into the frontalis muscle.
Furthermore, forehead lines should not be treated without first treating the glabellar complex. Brow ptosis is more likely if the frontalis or forehead muscle is overly relaxed while the glabellar complex remains active. This is due to the glabellar complex’s tendency to pull the brows down.
Treatment:
If there is pre-existing lid heaviness and frontalis hyperactivity, consider not treating the forehead, reducing the dose, or treating high in the frontalis. Alternatively, it might be necessary to treat the residual corrugator, procerus, and orbicularis oculi activity to counteract frontalis drop.
If the lids feel heavy as a result of brow ptosis or overrelaxation of the frontalis muscle, make sure there is no activity in the glabellar complex.
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