There are several causes of drooping eyebrows, also known as brow ptosis. However, drooping brows are most commonly a part of the natural aging process. As we age, the forehead and eyebrows can develop skin laxity and begin to sag. Additionally, the muscles that we use to make facial expressions have to work harder. The muscles pull down, and over time, the set of opposing muscles that manage the eyebrows will allow them to droop. This gives people an angry or tired appearance.

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.

If you would like to correct a drooping brow after having a Botox injection, our board-certified facial plastic surgeon, Dr. R. William Thompson can help. Dr. Thompson, founder of Thompson Facial Plastics in Denver is an expert in surgical facial anatomy and has applied Botox to thousands of patients in the Denver area.

What is Botox and How Does It Work?

Botulinum toxin type A, or Botox, is a specific brand of neuromodulator commonly used for facial rejuvenation procedures. Botox was first approved for cosmetic use in 2002 by the FDA as a temporary treatment for moderate to severe frown lines. Since then it has also been approved for treating crow’s feet and forehead lines. It has several non-cosmetic therapeutic applications, as well.

Botox is a naturally purified protein. When injected into facial muscles, it blocks the release of acetylcholine, a neurotransmitter that signals muscle contraction, relaxing the overlying skin to give it a smoother, more youthful appearance. Only the targeted muscle should be affected.

Patients normally have minimal swelling or bruising that resolves quickly. Results can be seen 3 days post-injection and the results generally last for three to four months. The effect will gradually start to wear off as the protein clears from the body and then the muscles will be able to contract again.

What Causes Droopy Eyebrows After Botox Treatment?

Botox is an effective way to temporarily combat wrinkles and frown lines, but it can also cause drooping eyebrows. Besides being aesthetically unpleasant, if the brow falls below the browbone, then it can obstruct a person’s visual field.

When Botox is injected into the forehead to smooth the forehead wrinkles, it affects the frontalis muscle. This temporarily stops the frontalis muscle (which raises the eyebrows and extends to the upper forehead) from contracting for about three to four months- until the Botox is metabolized by the body and excreted.

However, brow ptosis can result when too many units of Botox are injected or when the injection site is too low on the forehead. 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.

Brow ptosis might also be a result of neglecting to inject Botox into the glabellar complex muscles. The glabella area is between the eyebrows and above the nose. These muscles are used to lower our eyebrows, and if they are not relaxed, then they continue to pull down- unopposed by the relaxed frontalis.

The muscles for the eyebrows function as a team. If the surrounding areas of the eyebrows are not injected, it might be because the patient does not have any other lines that bother them enough to want treatment. However, experienced injectors should know that they are supposed to properly balance the muscles and they should educate patients on this issue to minimize the potential for this side effect.

Patients in this situation can work with Dr. Thompson at Thompson Facial Plastics to correct drooping eyebrows from Botox. Dr. Thompson will properly evaluate the cause of the problem and then be able to give you a more awake and alert appearance.

What Can I Do About Drooping Eyebrows After Botox?

Since Botox is a temporary treatment, this problem will usually go away on its own over time without any treatment necessary. However, this will take about four weeks and most patients do not want to wait that long.

Additional Botox Treatment

When you want to make a correction to a Botox procedure, you’ll want to consult with a board-certified plastic surgeon. The doctor will do a facial examination to determine what caused the eyebrow droop, determine whether you are a candidate for more Botox, and make the best plan for the correction.

At your appointment with Dr. Thompson, he will evaluate the problem and help restore you to the refreshed, awake appearance that you wanted.

Eye Drops

Eyebrow droop can cause the skin of the upper eyelids to sag downward and cover some of the eyes. Droopy eyelids can be treated with prescription medicated eye drops, such as lopidine, along with other treatments for directly treating the eyebrows.

How to Avoid Drooping Eyebrows After Botox Injections

The best way to avoid eyebrow droop is to choose a licensed, experienced practitioner. However, not all side effects are caused by inexperience- there are individual differences in how patients react to Botox.

Follow Aftercare Instructions

Following post-procedure instructions is very important in minimizing the possibility of eyebrow droop after Botox. Patients are asked to avoid lying down or rubbing/touching the face for a minimum of 4 hours. This will help keep the Botox from migrating to other muscles. In addition, for at least 24 hours, you should:

  • Avoid make-up and tight headwear.
  • Avoid alcohol.
  • Avoid sleeping on your face.
  • Avoid sun exposure or heat.
  • Avoid strenuous activity.

You will also be given a short list of medications to avoid for a brief time.

Choose An Expert To Fix Eyebrow Droop After Botox

Whether it be for the initial procedure or to fix eyebrow droop, always choose licensed, experienced injectors who are trained in facial anatomy. Botox is used to manage muscle contractions and only an educated and credentialed practitioner will understand how the underlying muscles work. Dr. Thompson is board-certified by the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS) and is considered an expert on surgical facial anatomy.

A proper Botox procedure starts with an examination of the face. Facial anatomy differs from person to person and the exam is a critical step before the actual procedure. At the exam, tell your physician about any medications or other previous facial procedures, as tissue and anatomy might have been altered this way.

The examination will help to determine whether strategically injecting more Botox will remedy the problem. How much (how little), how deep, and where to inject the Botox are determined by a good evaluation.

Your doctor should discuss all of your options and the reasoning behind them. Sometimes this plan might combine techniques or a patient might even be told that they are not a good candidate for more Botox.

 Why Choose Dr. William Thompson, M.D.?

  1. William Thompson, M.D. is an expert in correcting drooping eyebrows after Botox treatments. He is committed to providing his clients with the best possible plastic surgery care. If you have sagging eyebrows after botox treatment, he can help.

Dr. Thompson has the expertise and experience required to handle all facial plastic surgery techniques at his Denver, CO location.

If you want to know whether you are a candidate to correct a droopy eyebrow, schedule a consult with Dr. Thompson. Call (303) 622-3288 today.


Here are some frequently asked questions about drooping eyebrows after Botox treatment that might help you before visiting a plastic surgeon.

How do you fix droopy eyebrows after Botox?

Drooping eyebrows after injecting Botox can be caused by several things. It could be the result of too much botulinum toxin injected between their eyebrows, or from an improper injection technique. It could even be from too little Botox (or none) injected into the opposing muscles to keep them working together properly.

If you have droopy eyebrows after Botox, the best approach to the problem is to visit Dr. R. William Thompson, a facial plastic surgeon in the Denver area to advise you on a treatment solution that will return your eyebrows to a normal position.

Will Botox ptosis go away?

Brow ptosis, or eyelid drooping after Botox injections, can be a side effect of the treatment. The ptosis is almost always temporary and will go away over time. It usually takes about four weeks for ptosis to resolve and for some people, ptosis resolves sooner. However, patients do not have to wait, as there are safe and immediate solutions offered by Dr. Thompson at Thompson Facial Plastics.

Can you fix a dropped eyebrow from Botox?

Yes, typically dropped brows from Botox can be remedied easily and safely by an experienced practitioner. If you’ve had this treatment on your forehead, then the frontalis muscle responsible for raising the eyebrows may have become too relaxed. This will result in droopy brows (and sometimes droopy eyelids). Thompson Facial Plastics is experienced in fixing this problem.

What are the risks of Botox?

Botox has been used for over a decade and is one of the most well-known cosmetic procedures in the world. However, even though it is minimally invasive, there are some risks associated with Botox treatments. Some of these risks include bruising, headache, infection, drooping eyelids, an asymmetry between the brows and forehead, drooping eyebrows (brow ptosis), and lack of muscle control to raise eyebrows.

Can dermal fillers be used Instead of Botox injections?

Yes, dermal fillers can be used instead of Botox injections. However, for forehead lines, most doctors believe that Botox gives superior results because it was designed to affect the underlying muscle which is what gives the forehead a smooth, rejuvenated appearance. Dermal filler injections also have potential risks and side effects.

What can I do to prevent drooping eyebrows after Botox?

To help prevent drooping eyebrows after a Botox treatment, start by carefully selecting an experienced practitioner. Do not be swayed by promotions or discounts. Always choose a board-certified plastic surgeon or dermatologist to minimize the chance of complications. Also, follow post-procedure instructions as best you can.

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