Here, the most well-known adverse event is the eyelid ptosis which is caused by the diffusion of the BNT into the levator palpebrae muscles (see Fig. 5.23 in Sect. 5.2 on the treatment of the glabella).

Injections into the orbicularis oculi, corru-gator supercilii and procerus muscles have the highest risk of producing lid ptosis. Lid ptosis usually manifests within two to seven days and can last for weeks. Using Botox in the glabella area, Carruthers and colleagues reported a lid ptosis rate of 5.4% in their first large placebo-

BNT injections placed around the lower eyelid can affect the function of the orbicularis oculi muscle and lead to ectropion, causing corneal damage through desiccation. Potential risk factors are lower eyelid surgery or a higher age of patient.

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