# Botox Side Effects: Eyelid Drooping, Asymmetry, Frozen Look

> What are the possible side effects of botox? Why do eyelid and brow drooping, asymmetry, a frozen look, bruising, headache and weak results occur, how…

Published: 6 November 2026 · Medically reviewed by: Op. Dr. Murat Alpay

**What are the possible side effects of botox? Why do eyelid and brow drooping, asymmetry, a frozen look, bruising, headache and weak results occur, how long do they last, and how are they prevented and managed?**

Most side effects of botox (botulinum toxin) are **temporary and mild**. Unwanted results such as eyelid drooping, brow drooping, asymmetry and a frozen look depend largely on dose, injection point and technique. This is why a large part of the risk can be reduced by a physician who knows the facial muscles and anatomy well. This article explains the unwanted effects that can occur with botox, their causes, how long they last, how they are prevented and how they are managed. For the procedure itself, areas and duration of effect see our [botox](https://www.muratalpay.com.tr/en/tedaviler/botoks/) page and [botox in the face](https://www.muratalpay.com.tr/en/blog/yuz-bolgesinde-botoks-botulinum-toksin-uygulamasi-nedir/) article.

## Why Can Botox Cause Unwanted Effects?

Botulinum toxin temporarily blocks the signal between the nerve and the muscle it is placed in and relaxes the muscle. The problem arises when the substance spreads beyond the intended muscle. This is called **diffusion** (spread). The sources list the following as the main situations that increase diffusion:

- Preparing the substance too diluted, that is, in a large volume
- Injecting it too fast
- Rubbing or massaging the area after the procedure
- Injection points too close to the muscle edge or the bony rim

Toxin that spreads to neighbouring muscles can affect the eyelid, lip or smile muscles and lead to the conditions below.

## Eyelid Drooping (Ptosis)

**Cause:** Toxin used between the brows or around the eyebrow leaks to the muscle that lifts the upper eyelid. The muscle weakens temporarily and the eyelid droops.

**When it appears and how long it lasts:** It can be noticed in the first 48 hours or within 7-10 days after the procedure. It resolves on its own, and the sources report that it generally lasts 2-4 weeks.

**How it is prevented:** Injections are advised to stay at least 1 cm above the bony rim of the eye socket, with the needle entering the muscle at a right angle, and to avoid the risky zone very close to the brow.

**How it is managed:** Certain eye drops prescribed by the physician that lift the eyelid by a few millimetres can be used until the drooping resolves. See your physician rather than choosing drops yourself.

## Brow Drooping

**Cause:** Too high a dose in the forehead muscle (frontal muscle) that is the only muscle lifting the brow, working too close to the brow, or relaxing the whole muscle. There is also this situation: people with slightly low eyelids often compensate without noticing by tensing the forehead. When the forehead muscle is relaxed, this hidden droop can show.

**How it is prevented:** Care for the lower part of the forehead muscle, injecting above the first horizontal line that forms when the brow is raised, and avoiding too high a dose are advised.

**How it is managed:** Relaxing a small amount of the muscles that pull the brow down can help lift the brow. The duration is limited by the effect time of the dose used.

## Asymmetry

**Causes:** The injection points or dose not being planned equally on both sides; injections concentrated in the inner part of the forehead leaving the outer fibres free, so the tails of the brows rise too much; or toxin leaking to the smile muscles around the crow's feet and mouth, causing an uneven smile.

**How it is prevented:** Before the procedure the person is asked to make expressions so the working of the muscles and any natural asymmetries are assessed. For crow's feet, staying at least 1 cm outside the bony line at the outer eye corner and not going too deep is advised.

**How it is managed:** About 2 weeks are waited after the first procedure so the muscle response settles. A small touch-up to the area that stays mobile can then restore symmetry.

## Frozen (Mask-Like) Look

**Cause:** Mainly high doses in the forehead and between the brows, locking the expression muscles completely.

**How it is prevented:** Instead of locking the muscle completely, the aim is to soften it and open the lines with more superficial, multi-point, low doses.

**Duration:** As the effect on the muscle fades, facial expression gradually returns to normal within 3-4 months.

## Headache, Bruising and Swelling

- **Headache:** May be related to the needle touching the membrane over the bone or to muscle response. It is usually mild, passes on its own or eases with simple pain relievers.
- **Bruising:** Caused by the needle touching small surface vessels. It is usually absorbed within 7-14 days.

**The sources list the following to reduce bruising:**

- Stopping drugs and supplements with a blood-thinning effect (aspirin, some pain relievers, vitamin E, ginkgo, garlic, ginseng, green tea) about 1 week before the procedure, in consultation with the physician
- Cold application before the procedure
- Light pressure on a bleeding point right after injection
- Cold compresses afterwards

Do not stop your medicines without asking your physician; especially if you take medicine for the heart or vessels or for clots, the decision must be made together with the physician.

## When the Effect Is Weak ("Botox Did Not Take")

The main reasons botox does not give the expected effect are listed in the sources as:

- Too low a dose
- Wrong depth or wrong point
- The toxin losing potency during preparation and storage (shaking too fast, freezing, not storing it under suitable conditions after preparation)
- The body developing antibodies against the toxin

**When can it be repeated?** Before a touch-up for an incomplete area, at least 10-14 days are waited so the muscle response settles. For a new main session, the sources advise not treating at intervals shorter than 3 months.

## Antibody Development and Resistance to the Toxin

In some people the body can develop neutralizing antibodies against the toxin. The sources report this rate as roughly 3-10%. Factors that increase antibody risk are:

- Very high doses
- Frequent repeats at intervals shorter than 3 months
- Frequent touch-ups and extra doses
- Starting at a young age

**Approaches that reduce the risk:** Using the smallest effective dose that gives the desired result, keeping at least 3 months between two sessions, and avoiding frequent touch-ups.

## Spread and Whole-Body Effects

With the small amounts used in the face, the risk of the general poisoning picture called botulism is very low. At high doses, temporary general muscle weakness, dry mouth or flu-like symptoms have been reported. Allergic reactions (swelling, hives) and, very rarely, severe allergic shock can occur. Problems such as difficulty swallowing have also been described with neck treatments. This is why areas such as the neck and lower face require particular experience.

## Who Should Not Have Botox?

- During pregnancy and breastfeeding
- With diseases that affect the nerve-muscle junction (such as myasthenia gravis, ALS, Eaton-Lambert syndrome)
- With an active infection, inflammatory skin disease or eczema in the area to be treated
- People with a known allergy to the toxin or to the human albumin it contains
- People with a bleeding disorder or taking blood thinners (limited because of the risk of bruising and of a hematoma, a collection of blood under the skin)
- People taking certain drugs that affect nerve-muscle transmission (such as some antibiotics, calcium channel blockers, magnesium, cyclosporine). Tell your physician about all your medicines before the procedure.
- People with unrealistic expectations or a body image disorder

## When to See a Physician After the Procedure

- Marked drooping of the eyelid or brow, double vision or being unable to close the eye fully
- Difficulty swallowing or speaking
- Widespread muscle weakness
- Shortness of breath, widespread hives or swelling of the face
- Pain or redness that increases as days pass

## Frequently Asked Questions

### Is botox-related eyelid drooping permanent?

No. The sources describe it as a self-limiting condition that usually lasts a few weeks. The duration varies from person to person.

### Will my face look frozen after botox?

It is not a necessary result. A frozen look is usually linked to a high dose and locking the whole muscle. With a plan that softens the muscle with low doses, expressions can largely be preserved.

### If botox did not work, can I have it again right away?

Not right away. At least 10-14 days for a touch-up and at least 3 months for a new main session are advised. Frequent repeats can raise the antibody risk.

### Can I massage my face after the procedure?

No. Massage and rubbing can make the toxin spread to neighbouring muscles. Follow the aftercare advice your physician gives.

### How is resistance to botox prevented?

Using the smallest effective dose, leaving at least 3 months between sessions and avoiding unnecessary touch-ups lower the risk.

Results of any surgical or interventional procedure may vary from person to person. It is recommended that you get detailed advice from your physician before the procedure.

Written and reviewed by

**Op. Dr. Murat Alpay**

Specialist in Obstetrics and Gynaecology · Istanbul University, Istanbul Faculty of Medicine (Çapa)

[Full biography →](https://www.muratalpay.com.tr/en/hakkinda/)

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Original page: https://www.muratalpay.com.tr/en/blog/botoks-yan-etkileri-goz-kapagi-dusmesi-asimetri-etki-yetersizligi-nasil-onlenir/  
Last updated: 2026-11-06

Op. Dr. Murat Alpay — Specialist in Obstetrics and Gynaecology  
Op. Dr. Murat Alpay Practice, Tekelioğlu Cd. No:51 B Kat:2, Filo Apt., 07160 Muratpaşa / Antalya  
0505 351 77 88 · Monday – Saturday 09:00 – 18:00 · Closed on Sunday

*This information is for general guidance only and does not replace examination, diagnosis or treatment.*