Britney Spears’ Botox Complication Is a Textbook Case of Eyelid Ptosis

Britney Spears’ recent Instagram post is doing double duty: part personal confession, part inadvertent PSA about a Botox side effect many people don’t know about. In a video posted August 7, the singer said a recent Botox appointment left her left eyelid visibly drooping for nearly a month—a textbook case, dermatologists say, of a well-documented, low-risk and fully reversible complication called ptosis.

Denver, CO dermatologist Joel L. Cohen, MD says the condition is nothing to worry about—it’s 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 Botox and other botulinum neuromodulator agents for plastic surgeons, dermatologists and aesthetic physicians. “This is a well-known entity that’s thoroughly reviewed in every textbook, 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.”

Spears’ own four-week timeline tracks almost exactly with that recovery window, but Dr. Cohen warns the answer isn’t 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.”

There’s no way to prevent every possible side effect, Dr. Cohen says, and his advice applies whether you’re sitting in a board-certified dermatologist’s office or a medspa chair. “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.” He adds that a prescribing injector also needs a full picture of a patient’s other medications, allergies and health conditions to avoid dangerous interactions or side effects.

His reassurance for anyone nervous about trying Botox: “Fortunately, eyelid ptosis after botulinum injection treatment is extremely rare, not serious and will resolve on its own, but it can definitely be minimized with prescription eyedrops.” All of which is to say, don’t let one viral video scare you off Botox for good.