Droopy eyelid after Botox: why, how long and what to do

A drooping eyelid, which doctors call eyelid ptosis, is one of the best-known eyelid problems after a botulinum toxin injection. It affects only a small proportion of injections and does not put the eye at risk, but it is bothersome, visible and sometimes worrying. A review of the literature stresses that it remains rare, and more frequent when the practitioner has little experience¹. This page answers the seven questions people ask most often. If your eyelid has just started to droop, remember this first: the effect is known, it is temporary, and your doctor can help you while you wait for it to go away.

Why does the eyelid droop after an injection?

The upper eyelid is held open by a muscle called the levator of the upper eyelid, located inside the eye socket. When botulinum toxin injected into a nearby area, most often between the eyebrows, spreads to this muscle, it weakens it too: the eyelid drops¹. An anatomical study by the authors of the same review showed that a small opening in the bone, present above the eye in some people, can act as a direct passage from the eyebrow area to the roof of the eye socket¹.

This is why the labels ask practitioners to avoid injecting near the levator muscle of the eyelid, and specify how high above the rim of the eye socket the injection points should be^2,3,6. A review also recommends staying 1.5 cm above the eyebrow, in line with the pupil, when treating the forehead⁷.

Ptosis is described in the labels of type A toxins as well as in that of the short-acting toxin. For one type A toxin, it is common after treatment of frown lines²; for another, it is uncommon⁶. With the short-acting botulinum toxin (serotype E), it was reported in 0.17% of patients³. These frequencies come from different trials: they cannot be used to compare the products.

How soon after the injection does it appear?

It usually appears 3 to 14 days after the injection¹. In trials of a type A toxin covering treatment of the forehead and frown lines, the median time to onset was 9 days after treatment². For the short-acting toxin, whose first effects appear from 8 hours³, this time has not been published.

How long does it last?

Most often a few weeks: the eyelid lifts again as the effect of the toxin wears off¹. In one case series, however, troublesome ptosis persisted from 6 weeks to 13 months⁴. The authors suggest a benchmark: in patients whose eyelid lifts with apraclonidine eye drops after a one-week trial, the ptosis probably resolves within 4 to 6 weeks; in those who do not respond, it may last longer⁴.

Duration also depends on the toxin injected: about 2–3 weeks of effect for the short-acting toxin³, several months for a type A toxin². The short-acting toxin is approved for frown lines in the European Union since 15 July 2026 and in Canada since 22 June 2026^8,9. These durations are explained on the page about how long botulinum toxin lasts, and the comparison of the two families of toxins summarises their profiles.

Is it reversible?

Yes. Ptosis goes away on its own when the effect of the toxin wears off and the levator muscle regains its strength¹. No product "reverses" the toxin, but recovery is spontaneous¹; in rare cases, it can take several months⁴.

Is there a treatment?

Eye drops prescribed by a doctor, containing apraclonidine or oxymetazoline in particular, can partly lift the eyelid while you wait for recovery^1,4. Oxymetazoline eye drops were evaluated in two phase 3 trials in adults with acquired ptosis: they lifted the eyelid within minutes of being applied, and this effect was maintained at day 42⁵. These trials did not specifically involve ptosis caused by botulinum toxin.

These eye drops act on a small accessory muscle of the eyelid; they do not make the toxin wear off any faster. The review also mentions other options, to be discussed with a specialist¹. No massage, cream or exercise has shown any effect in the sources we consulted. The eye drops are used only on prescription, after an examination: the doctor first checks that they are suitable for you.

What should you avoid?

Do not use eye drops without medical advice. Do not change a current treatment on your own. Avoid massaging the area or manipulating the eyelid. Do not try to "correct" the problem with an early new injection: after a short-acting toxin, a type A toxin injected less than 30 days later has not been evaluated³. Avoid driving if the eyelid gets in the way of your field of vision: the label of a botulinum toxin points out this risk³.

When should you see a doctor?

Talk to your doctor as soon as the eyelid droops, to confirm that this is what is happening, and not an eyebrow that is dropping, and to discuss eye drops. See a doctor without delay if the eye becomes painful or very dry, if the eyelid covers the pupil, or if the problem is not improving. For this appointment, write down the date of the injection, the area treated and the day the eyelid started to droop: these details help confirm the link with the injection.

Other problems can affect the same area, such as puffy eyelids after an injection, or an eyebrow that droops, which is often confused with a drooping eyelid.