Here’s why you may not need Botox after upper eyelid surgery

Q . Ever since I did my upper eyelid surgery, it seems I don’t need Botox anymore. Is that possible or my imagining things?

A. Yes, that’s absolutely possible, and I see it quite often. The brain is focused on maintaining clear vision. When there is excess upper eyelid skin, even if it’s subtle, it can weigh down the lids and partially obstruct the visual field.

The brain compensates by activating the forehead muscles to lift the brows. This constant “lifting effort” creates the horizontal forehead lines that we typically treat with Botox.

When an upper-eyelid procedure removes that extra skin, the eyelids feel lighter and the visual field improves. Because of that, the brain no longer needs to recruit the forehead muscles to elevate the brows. With less chronic muscle activation, those forehead wrinkles soften naturally, and patients often notice they don’t feel the same need for Botox.

I’ve had many patients over the years who were consistent Botox users for forehead lines, and after their upper eyelid surgery, they either significantly reduced their Botox use or stopped altogether. It’s not that Botox becomes ineffective, it’s that the underlying reason for needing it has changed.

That said, this varies from patient to patient. Some individuals still have strong muscle activity or aesthetic preferences that lead them to continue Botox.

But in many cases, especially when the primary issue was heaviness of the upper lids, surgery alone can create a smoother, more rested appearance.

Dr. Carlos Wolf is a partner in Miami Plastic Surgery and is board certified. Email questions to him at Cwolf@miamiplasticsurgery.com