Any dysfunction in the function of the levator palpebrae superioris muscle can cause drooping of the eyelid, known as ” Ptosis”. The degree of ptosis can range from a few millimeters to complete eyelid drooping and closure.

One of the most common side effects of injecting botulinum toxin type A is temporary eyelid ptosis. Improper injection in the glabellar sites, which are the areas between the eyebrows and above the brow, can lead to ptosis and drooping of the eyelid. In this case, the neurotoxin is transferred to the levator palpebrae superioris muscle through the thin membrane, causing muscle weakness after two to ten days of neurotoxin injection. Ptosis can occur in one or both eyes, ultimately resulting in facial asymmetry. This side effect is highly undesirable and concerning for individuals who have used neurotoxin to achieve a more youthful appearance.

The spread of neurotoxin to non-target areas and the occurrence of ptosis depends on the expertise and knowledge of the specialist physician regarding facial anatomy, depth, and location of different muscles. Since individuals’ skin varies in thickness and elasticity, understanding these differences and examining the history of diseases such as facial surgeries, ptosis, and conditions like multiple sclerosis by a specialist physician minimizes the occurrence of ptosis.

The selection of volume, dosage, concentration, and appropriate injection technique by a specialist physician directly affects the occurrence of ptosis.

Studies in this field have shown that injecting neurotoxin directly into the muscle center causes its spread to surrounding areas and the occurrence of ptosis, while multiple injections along the muscle reduce the occurrence of ptosis.

The specialist physician should have a complete understanding of the concentration and volume of the injected neurotoxin, as injecting neurotoxin in high or lower-than-standard volumes can cause its movement from the target muscle to surrounding areas and increase the likelihood of ptosis.

Preventive measures to avoid ptosis:

• Select and consult with a specialist physician.
• Provide the physician with complete information about medical history and skin conditions.
• Observe comprehensive post-injection care instructions.

Post-injection care measures that help reduce the occurrence of ptosis:

• Do not touch the injected area
• Avoid taking showers and washing the face with hot water
• Do not bend or lie down with the head lowered
• Avoid smoking
• Avoid heavy exercise
• Consult with your physician before undergoing laser treatments, micro-needling, and microdermabrasion

Treatment for ptosis:

Botulinum toxin injection is a temporary treatment method, and its effect gradually diminishes after a few months. Typically, the effect of neurotoxin completely disappears 3 to 7 months after injection, but ptosis caused by botulinum toxin injection resolves more quickly, and it is expected to resolve spontaneously after 4 to 6 weeks (or in some cases, 3 to 4 months). In addition to the passage of time, there are other methods that can help improve ptosis more rapidly. The use of appropriate eye drops, such as Apraclonidine, Brimonidine, and Naphazoline, which are prescribed by physicians, can assist in the restoration of eyelid muscle activity and contraction.