Why does my eyebrow droop after Botox?

The dreaded brow droop is often confused with eyelid droop after Botox. When Botox was first introduced the eyelid droop was the most feared. Eyelid droop usually resulted from blocking the elevator muscle when the injection was placed very close to the eyebrow and the product migrated down into the upper eyelid elevator.

What I have seen for more frequently is brow ptosis or a drooping eyebrow as a result of Botox placement. Because the frontalis muscle is an eyebrow elevator, placing too much product too far laterally in the forehead can entirely block the frontalis muscle and lead to a droopy eyebrow. In patients who are younger, typically in their mid-30s to early 40s, usually this is not a significant consequence. However in patients who have upper eyelid hooding as a result of pre-existing brow ptosis Botox injections can lead to worsened upper eyelid hooding, angry appearance, and excessive upper eyelid skin.