Britney Spears says botox left her eye drooping for weeks — here's why it happens

Pop star Britney Spears has revealed she experienced eyelid drooping after a botox procedure, drawing renewed attention to the side effects of cosmetic botox. Botox is widely used for wrinkle reduction and the treatment of certain medical conditions, but areas around the eyes — where muscles and nerves are densely packed — carry a risk of complications depending on injection placement and dosage.

Spears recently posted a video on social media pointing to her left eye and saying a doctor had injected too much botox into it. "My eye just slid down like this," she said. "My eye was drooping for four weeks. I was so embarrassed."

She then warned followers to "be careful with botox because it can completely ruin your face and body." Earlier, Spears disclosed that a botox procedure in 2023 left her face bruised and kept her from going out for about two weeks, after which she said she would hold off on botox for now.

The symptom Spears described is consistent with botox-induced ptosis, one of the most commonly reported side effects of cosmetic botox. Ptosis refers to a condition in which the eyelid droops lower than normal, causing the eye to appear less open.

Botox works by using botulinum toxin to temporarily block nerve-to-muscle signals, reducing muscle contractions. For cosmetic purposes, it is commonly used to smooth crow's feet around the eyes, frown lines between the brows and forehead wrinkles. It is also used to soften prominent vertical neck bands and to treat hyperhidrosis, chronic migraines and muscle spasticity.

Problems arise when the injected substance spreads beyond the intended muscle into surrounding tissue. Eyelid drooping can occur when botox migrates from muscles near the forehead or between the brows toward the levator palpebrae superioris — the muscle responsible for lifting the upper eyelid — weakening its function.

The area around the eyes and brow is particularly delicate, with small muscles, nerves and blood vessels in close proximity. Injecting an excessive dose into a specific spot, or placing the needle too close to the eyebrow or eyelid, raises the risk of side effects including drooping eyelids, sagging brows, swelling and bruising. In rare cases, patients may experience dry eyes or double vision.

Botox effects are not permanent, however. Cosmetic results typically last three to four months, and side effects generally resolve on their own over time. Spears herself said the drooping lasted about four weeks.

If symptoms are severe enough to impair vision or interfere with daily life, a visit to an ophthalmologist or plastic surgeon is advisable. In some cases, eye drops that temporarily lift the eyelid by about 1 to 2 millimeters may be prescribed. These work by stimulating contraction of Müller's muscle on the inner surface of the eyelid to relieve the drooping.

Post-procedure care also matters. Immediately after a botox injection, patients should avoid rubbing or massaging the injection site to prevent the substance from spreading to nearby muscles. Providers generally advise avoiding strong pressure, rubbing, strenuous exercise and saunas for about four to six hours after the procedure.

The most important factor in botox treatment is determining the right dosage for each individual's facial structure and muscle movement. Different products have different unit strengths and diffusion characteristics, and even in the same area the amount needed can vary from person to person depending on muscle size and movement. For repeat procedures in particular, finding the minimum effective dose that preserves natural facial expressions matters more than simply injecting more frequently or in larger amounts.

The American Academy of Dermatology recommends consulting a qualified medical professional — such as a board-certified dermatologist with sufficient experience — before undergoing botulinum toxin treatment. Patients should avoid products of unclear origin and procedures performed outside licensed medical facilities. Those with a history of dry eye syndrome, eyelid drooping or surgery around the eyes should disclose this to their provider beforehand.