A Dermatologist Explains the ‘Botched Botox’ Situation That’s Suddenly Going Viral


A Chicago-based beauty blogger has taken to social media to share her story of “injectables gone bad.” As Whitney Buha told her followers and BuzzFeed News, a trip to her local med spa for some Botox Cosmetic left her with one droopy eyelid—aka, a condition called ptosis—which seemed to worsen as the days went on. 

While the personal chronicling of the condition has gotten a lot of buzz, Denver, CO dermatologist Joel L. Cohen, MD says it’s not necessarily something to cause concern, as it is both rare and reversible. 

“Eyelid ptosis (droop) is a known risk after Botox in the upper face, at about 1-percent in most clinical studies when the area between the eyebrows, or the glabella, is treated,” says Dr. Cohen, who has published, as lead-author, one of the largest academic textbooks on how to use Botox and other Botulinum neuromodulator agents for plastic surgeons, dermatologists and aesthetic physicians. “This eyelid ptosis is a well-known entity that is thoroughly reviewed in every textbook and paper and clinical trial on Botox and its competitors.”

As Dr. Cohen explains, eyelid ptosis can happen (in rare cases) if the injection liquid diffuses to a muscle in the eyelid that functions to lift the upper eyelid upwards, which is called the levator palpebrae superioris muscle. “It is important that this is differentiated from eyebrow ptosis, which occurs when the forehead muscle that lifts up the brows is overinjected in some people.”

“For experienced injectors, the risk of eyelid ptosis is usually even lower than 1 percent, but still not zero,” he adds. “Experienced injectors know about this entity, know it can rarely occur and, most importantly, know how to minimize it with specific drops to be much less apparent—as the condition gradually resolves over several weeks. In this eyelid ptosis case, at minimum, her injector should have known about iopidine drops and how they work. It’s obviously BEST if your injector has a license to prescribe medications like these prescription drops to help improve the situation until things resolve.”

Dr. Cohen also warns that the answer is not to do more Botox to treat a case like this. “We only routinely do that for brow ptosis to decrease the lateral and top of the muscle around the eye [called the orbicularis oculi muscle] from pulling down the outer aspect of the eyebrow. So, this BuzzFeed article is not only confusing the two issues, but also misleading people that more is an actual treatment for lid ptosis, when it actually only for brow ptosis—and in the two weeks the person says it will take to kick-in, it simply won’t take care of the issue.”

In short, Dr. Cohen concludes, there is no way to prevent potential side effects from an aesthetic treatment every single time a treatment is done. “But minimizing risk is what folks should want and seek. It’s important for patients to ask their injector about their experience—and they should have a lot more than just a weekend-course certificate. They should have years of education like a medical residency where anatomy and aesthetic procedures are taught and re-taught, and then routinely tested. It’s also important to ask if your injector has the ability to write a prescription, in case a complication occurs, or, at the very least, has an on-site physician or access to one available at all times. When writing a prescription, understanding other mediations and other medical conditions are important when prescribing, as we are always concerned about medication interactions, mediation allergies and medication side effects.”

“Fortunately, eyelid ptosis after botulinum injection treatment is extremely rare, not serious, will resolve on its own, but it can definitely be minimized with prescription eyedrops.”

For more information on what it takes to become an expert injector, click here.

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