Botox, the brilliant paralyzing injection known for healing wrinkled foreheads and furrowed brows worldwide, was officially approved by the Food and Drug Administration in 2006. Botox has very few side effects; however, one of the most troubling to patients is when an eyelid droops. This side effect is rare, but before you get Botox, you may want to understand what it is and how it happens.

Why Drooping Occurs

Any Botox administered around the eye has the potential to affect the muscle that opens the upper eyelid. Botox can spread from an injection site approximately 1 inch or 2.5 cm. Since Botox is a paralyzing toxin, the muscle that opens the lid is technically also paralyzed, which may make it difficult to open the eyelid fully.

Poor location of the injection and excessive doses of Botox are the culprits of eyelid drooping. Too much Botox raises the risk of it traveling to areas it shouldn’t, increasing the chance of a drooping eyelid. Location of the injection, experience of the person injecting the Botox and knowing certain facts—such as the patient should remain in an upright position during the injection and three to four hours after injection—are all factors that lessen the risk of drooping eyelid.


Drooping of the eyelid happens less than 1 percent of the time. Frown line injections and/or injections underneath the “tail” of the eyebrow (to create a brow lift effect) are the treatments that have the most likelihood of producing a droopy eyelid.

How Long It Lasts

The drooping eyelid syndrome is not permanent. It will most likely wear off before the Botox does. If eyelid drooping starts three to four days after the injection, it will most likely last three to four weeks. If the drooping begins four to six days after the injection, it should go away faster.


Eyedrop treatments, such as Alphagan or lopidine, can diminish the lid droop by pulling up the eyelid a bit (anywhere from 1 to 3mm). These drops can help stimulate a different muscle that wasn’t affected by the Botox.


After receiving a Botox injection, do not massage the injected region. Do not take a siesta, but remain upright for at least three to four hours. Also, try to use the muscles around the eye. Deliberately making the muscles tighten helps confine the protein to the chosen muscle for ablation.

If your doctor is selling pretty eye patches in her waiting room—find another doctor.