August 13, 2021

Know this and you will avoid eyelid ptosis after Botox treatments

Dr Tim Pearce shares essential insights into eye anatomy that can help injectors avoid unpleasant and dangerous eyelid ptosis complications. 

Tim explains:

“It’s a really common problem and actually I’m really convinced you just need to have a little bit of knowledge and it will change your injection technique and the rate of eyelid ptosis will drop through the floor, because using this knowledge we have an injection technique that drops the rate from what the published data says, which is 1 in 100, to what in my experience is less than 1 in about 15,000.

“So really no need to have to deal with people with droopy eyelids and it all comes from understanding the anatomy.”

Eyelid Ptosis From Botulinum Toxins

Understanding The Crucial Anatomy

This video is from 2016 and has been viewed over 11,000 times on YouTube.

Where does botulinum toxin actually go when you get an eyelid ptosis?

It’s the levator palpebrae superioris that lifts the upper lid, and it’s this muscle that is behind eyelid ptosis after a Botox, Xeomin, Azzalure or Bocouture treatment.

levator-palpabrae lateral view eye anatomy

The dreaded droopy eye symptom is easily avoided if you understand the anatomy.

Depth is key, especially when you are injecting the lateral corrugator muscle while relaxing frown lines.

The key to understanding the problem is to understand the anatomy from a sagittal view so that you see the depth of the levator palpebrae muscle into the orbit.

Most people assume the muscle is close to the external eyelid they see, and get nervous as they get closer to the lid.

Sadly it’s actually depth of the lateral corrugator injection as you come close to the mid pupillary line that is the risk.

As illustrated in the video, depth is your enemy here, as once you pass through the orbicularis oculi there is a potential path for the injected botulinum toxin to pass down into the orbit and affect the eyelid.

Dr Tim explains the anatomy of the corrugator muscle:

“It starts deep and attached to the bone and gets gradually more superficial until round about the mid pupillary line is actually above the frontalis muscle, above orbicularis oculi and is embedded in the skin.

“And that’s how our injections should work as well, that we start deep where it’s safe and we’ve actually got quite a distance from the relator muscle – we get medium depth around here – when we’re at the most risky point we make sure that we’re above orbicularis oculi and within the dermis of the skin where the insertion point of the corrugator is; and that will make sure that we’re not able to get product trickling down into the space and causing an eyelid ptosis.”

The injection technique is covered on Dr Tim Pearce’s BOTOX® foundation eLearning course which is now on this website,

BOTOX® eLearning Courses

Learn more about the fundamentals of botulinum toxin injections with Dr Tim’s eLearning course BOTOX® foundation eLearning course. This eLearning course includes a series of videos designed to support those starting out in aesthetics, providing ongoing resources after face to face tuition.

For further learning, the next step is our Botulinum Toxin Complications Mastery course. This is an illustrated and animated video guide to BOTOX® complications including Ptosis (eyelid, brow, cheek, lips), Oedema, Haematoma, Asymmetry, Flu Symptoms. It helps clinicians learn how to manage and avoid BOTOX® complications based on sound understanding of anatomy and techniques to minimise risk.

Are you still anxious about delivering cosmetic injectables safely?

If you want to learn more about mastering medical aesthetic treatments and complications or conquering the anxiety of where to place your needle, then register for the next Dr Tim webinar.

Subscribe to our YouTube channel for really useful regular tips and advice. YouTube

Dr Tim Pearce eLearning

Dr Tim Pearce MBChB BSc (Hons) MRCGP founded his eLearning concept in 2016 in order to provide readily accessible BOTOX® and dermal filler online courses for fellow Medical Aesthetics practitioners. His objective was to raise standards within the industry – a principle which remains just as relevant today.

Our exclusive video-led courses are designed to build confidence, knowledge and technique at every stage, working from foundation level to advanced treatments and management of complications.

Thousands of delegates have benefited from the courses and we’re highly rated on Trustpilot. For more information or to discuss which course is right for you, please get in touch with our friendly team.

Get In Touch

Please leave a message