Journal of Clinical and Aesthetic Dermatology

DEC 2016

An evidence-based, peer-reviewed journal for practicing clinicians in the field of dermatology

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JCAD JOURNAL OF CLINICAL AND AESTHETIC DERMATOLOGY December 2016 • Volume 9 • Number 12 E 1 Introduction In aesthetic medicine, ptosis is almost exclusively related to the inadvertent injection of botulinum toxin type A into an unwanted area leading to muscle weakness and a resultant droop, particularly in the hands of an inexperienced injector. Depending on the area treated, ptosis can affect the brow resulting in a lowering of the eyebrows, which produces a poor cosmetic result but can also lead to a significant descent of the eyebrows that may interfere with vision. Upper lid ptosis may occur when treating the glabellar complex and botulinum toxin type A diffuses through the orbital septum and affects the lid elevator muscle either as it traverses the pre-periosteal plane or the toxin may track along tributaries of the superior ophthalmic vein. 1 This may result in a drooping of the upper lid with the patient unable to fully open the eye, a poor cosmetic result that may interfere with normal vision. Although ptosis may persist for the whole duration of effect of treatment with botulinum toxin type A, it will usually settle more quickly and eyelid ptosis will often settle within 3 to 4 weeks and brow ptosis within six weeks. 2,3 Incidence Allergan's Multicenter United States Food and Drug Administration (FDA) study revealed a 5.4-percent incidence of ptosis (12 out of 263); however, it was acknowledged that many of these complications were a result of an inexperienced injector. The reported incidence of experienced injectors is far less than this and more likely to be less than one percent. 4 Signs and Symptoms The patient will normally present within 3 to 7 days Management of Ptosis Martyn King, MD Definition Ptosis is derived from the Greek word for falling and is the medical terminology describing a drooping or abnormal lowering of an anatomical area. When ptosis pertains to the eyelid it is more accurately described as blepharoptosis. 1 JOURNAL OF CLINICAL AND AESTHETIC DERMATOLOGY Aesthetic complications Guidelines

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