The Truth About Ptosis, the Botox Side Effect That Went Viral

We found out why and how it happens from a plastic surgeon.

Person covering eyes

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At this point, everyone knows at least a little about Botox. Whether you've heard of it, tried it, or are thinking about trying it, you probably know about its wrinkle-eliminating benefits, wide-ranging applications, and origin story. With its meteoric rise in popularity in recent years, plus the amount of information available about the various uses, more people than ever are getting—or at least considering—Botox.

That demand has also improved awareness and sparked conversation regarding the stigma around injectables, which are often unfairly associated with shame and superficiality. Botox remains a safe, effective option for many looking to get in on its numerous benefits. However, as more people try cosmetic treatments, the potential side effects have also gained more visibility. Understandably, patients want to be fully informed about all possible outcomes, but it's important to remember that negative results are still relatively rare, despite what you might see on your Instagram feed. Like ptosis. 

Awareness of ptosis skyrocketed in April 2021 when Whitney Buha, a Chicago-based influencer, went viral after waking up with a droopy eyelid following an appointment with her plastic surgeon. Her content brought the internet's attention to this lesser-known (albeit still rare) outcome from Botox—over the course of a month, countless viewers followed along as she posted updates about her condition and shared solutions and progress photos.

"The first two weeks were the hardest as that's when my left eye was getting worse each day. After I passed the three-week mark, I started to see some improvement. It's been a long process of first trying to understand what exactly happened and, after understanding that, trying to find a way to speed up my recovery," Whitney told Cosmopolitan UK.

We tapped one of New York's top plastic surgeons to understand more about this rare side effect, including why and how it happens. Read on for what you need to know about Ptosis if you're considering Botox.

What to Know About the Botox Side Effect

What is Ptosis?

Ptosis is a muscle-related condition that causes an eyelid to droop lower than the other.

Ptosis is not specific to Botox, necessarily, as it’s often caused by aging or injury, but the good news is that Botox-related Ptosis is very temporary. Around 5% of people who get Botox will have problems with eyelid droop, and that statistic falls to less than 1% if a skilled doctor does the injection. Bottom line? Ptosis is incredibly uncommon, and finding the right plastic surgeon is the best way to ensure you get your desired outcome.

Why Ptosis Happens

According to Board-certified Manhattan-based plastic surgeon Dr. Konstantin Vasyukevich, there's a relatively simple reason for why the side effect occurs. “Botox, of course, as you know, works by paralyzing the muscles where it is injected. This is a beneficial effect because it lets the skin regenerate, and then wrinkles go away. Now all those muscles that are in and around the forehead, brows, and around the eyes are fairly small and fairly crowded,” Dr. Vasyukevich explains.

“So when Botox is injected into the area, occasionally, it migrates from the place it was injected into a neighboring area. And most of the time, it’s not a big deal because the neighboring muscles also benefit from being slightly more relaxed. But, there are some muscles we definitely don’t want to affect.” 

Effects of Ptosis

Ptosis affects the cosmetic appearance of an eyelid by forcing the muscle into a relaxed state, but in a few cases, it can also temporarily impair vision. The muscle that makes it possible to roll eyes can also be affected by Botox migration, causing temporary impairment of peripheral vision. “If one of those muscles is affected, then one eye would be moving, and the other would not move quite the same way. The eyes can become asynchronous. So when they look straight, everything’s fine, but when they look to the right, they might see double.” But, he reassures, this particular version is extremely rare.

How It's Treated

Dr. Vasyukevich explains that treatment includes a prescription eye drop that can restimulate the affected eyelid muscle, effectively helping it get back to the normal position while the Botox wears off. According to Vasyukevich, the effect will usually last around two to three months. It’s generally a fairly small amount of Botox that migrates to the neighboring muscle, not a full dose, so the side effect is shorter than a standard Botox cycle. Rest assured, if you’re experiencing Botox-induced ptosis, it will always go back to normal. 

The Bottom Line

If you’re curious about how to avoid the side effect, ptosis is still pretty uncommon in Botox users. However, Dr. Vasyukevich warns that while Botox migration is never 100% avoidable, more experienced administrators will have a much higher success rate when it comes to injectable facial treatments. Depending on each individual’s anatomy, the injection spot right between the eyebrows can sometimes be very close to the muscle that controls eyelid motion, so a small risk of ptosis is something anyone getting Botox should be aware of. Certain patients are predisposed to the condition, so if you have gotten ptosis from Botox in the past or more than once, it’s best to let your doctor know so they know to be particularly careful.

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