There is a reason that Cosmetic neurotoxins like botox and Jeuveau are so popular; these treatments improve wrinkles and have the bonus of opening the eye area. Oculoplastic surgeons love these medications because they improve the appearance of the entire eye area. Neurotoxins like botox are injected in three common areas in the upper face, the crows feet, glabella (between the brows) and forehead. One of the common questions Oculoplastic surgeons get asked is; can I get botox if I have an upper eyelid ptosis?
Upper eyelid ptosis is a droopy eyelid from a stretched out eyelid muscle. In these cases the patients use their forehead muscles (Frontalis muscle) to open their eyes. Most patients don’t even know they are using their forehead muscles to open their eyes. In patients with eyelid ptosis we have to be very careful about cosmetic neurotoxins as they can worsen ptosis or increase the asymmetry of the eyelids.
Patients with congenital ptosis and acquired ptosis develop eyebrow elevation which opens the upper eyelid. In older patients chronic years of lifting the forehead will cause them to have deep wrinkles. These patients will often seek cosmetic improvement of the forehead because they don’t like the wrinkles on the forehead. Unfortunately if these wrinkles are over treated the upper eyelid will become even more droopy because now the forehead muscle can not help lift the droopy eyelid. That is why Dr. Ahmad and Daisy try to educate their patients that although improved wrinkles on the forehead does freshen the look of the patient but not if it comes at the expense of worse drooping of the eyelids!
Patients with upper eyelid ptosis require an individualized plan of attack when using neurotoxins like botox or jeuveau. We usually recommend minimal neurotoxins on the forehead especially on the side of the forehead where the upper eyelid is heavier or lower. We also recommend treating the area between the eyebrows (glabella) and the crows feet as both these areas will help to keep the eyebrow from falling if too much neurotoxin has been given in the frontalis muscle(forehead muscle).
Very often Dr. Ahmad will recommend ptosis surgery to repair the droopy eyelid. In most cases the eyebrows will relax somewhat after surgical repair causing the wrinkles on the forehead to Improve. Once the eyelid has been repaired the patient can have more neurotoxin on the forehead to improve the appearance. We try to educate the patients that a forehead that is overly smooth, shiny or lacking movement is not a natural look for most patients. This type of appearance of a forehead tends to attract negative attention and takes away from the patients overall appearance. In general, less neurotoxin in the forehead leads to an overall better harmony of the upper third of the face. Please come and have us take a look at how we can better improve your appearance.