{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T23:38:21Z","timestamp":1792453101307,"version":"4.5.0"},"reference-count":79,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2021,8,11]],"date-time":"2021-08-11T00:00:00Z","timestamp":1628640000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2021,8,11]],"date-time":"2021-08-11T00:00:00Z","timestamp":1628640000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J of Cosmetic Dermatology"],"published-print":{"date-parts":[[2021,10]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Botulinum toxin A (BoNT\u2010A) has grown tremendously in aesthetic dermatology since 2002 when the United States Food and Drug Administration (FDA) first approved its use for treating moderate\u2010to\u2010severe glabellar lines. Blepharoptosis, due to local spread of toxin, is a reported side effect of BoNT\u2010A which, although rare, more frequently occurs among inexperienced practitioners.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>The purpose of this review is to highlight the causes and management of eyelid ptosis secondary to BoNT\u2010A administration including new anatomic pathways for BoNT\u2010A spread from the brow area to the levator palpebrae superioris muscle.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A literature search was conducted using electronic databases (PubMed, Science Direct, MEDLINE, Embase, CINAHL, EBSCO) regarding eyelid anatomy and the underlying pathogenesis, presentation, prevention, and treatment of eyelid ptosis secondary to BoNT\u2010A. Anatomic dissection has been performed to assess the role of neurovascular pedicles and supraorbital foramen anatomic variations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Blepharoptosis occurs due to weakness of the levator palpebrae superioris muscle. Mean onset is 3\u201314\u00a0days after injection and eventually self\u2010resolves after the paralytic effect of BoNT\u2010A wanes. Administration of medications, such as oxymetazoline hydrochloride or apraclonidine hydrochloride eye drops, anticholinesterase agents, or transdermal BoNT\u2010A injections to the pre\u2010tarsal orbicularis, can at least partially reverse eyelid ptosis. Anatomic study shows that a supraorbital foramen may be present in some patients and constitutes a shortcut from the brow area directly into the orbital roof, following the supraorbital neurovascular pedicle.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Providers should understand the anatomy and be aware of the causes and treatment for blepharoptosis when injecting BoNT\u2010A for the reduction of facial wrinkles. Thorough anatomic knowledge of the supraorbital area and orbital roof is paramount to preventing incorrect injection into \u201cdanger zones,\u201d which increase the risk of eyelid ptosis.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jocd.14361","type":"journal-article","created":{"date-parts":[[2021,8,11]],"date-time":"2021-08-11T04:06:44Z","timestamp":1628654804000},"page":"3133-3146","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":73,"title":["Botulinum toxin\u2013induced blepharoptosis: Anatomy, etiology, prevention, and therapeutic options"],"prefix":"10.1111","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8978-7932","authenticated-orcid":false,"given":"Mark S.","family":"Nestor","sequence":"first","affiliation":[{"name":"Center for Clinical and Cosmetic Research Aventura Florida USA"},{"name":"Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery University of Miami Miller School of Medicine Miami Florida USA"},{"name":"Division of Plastic Surgery Department of Surgery University of Miami Miller School of Medicine Miami Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haowei","family":"Han","sequence":"additional","affiliation":[{"name":"Center for Clinical and Cosmetic Research Aventura Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anita","family":"Gade","sequence":"additional","affiliation":[{"name":"Center for Clinical and Cosmetic Research Aventura Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Fischer","sequence":"additional","affiliation":[{"name":"Center for Clinical and Cosmetic Research Aventura Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yves","family":"Saban","sequence":"additional","affiliation":[{"name":"Facial Plastic and Maxillofacial Surgery Facial Anatomist Nice France"},{"name":"European Academy of Facial Plastic Surgery (EAFPS) L\u00fcbeck France"},{"name":"Rhinoplasty Focus Group Chennai India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberto","family":"Polselli","sequence":"additional","affiliation":[{"name":"Ear Nose Throat, Facial Plastic Surgery Private Practice in Marina di Carrara Marina di Carrara Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,8,11]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"publisher","DOI":"10.4103\/IJMR.2010_132_05_489"},{"issue":"3","key":"e_1_2_13_3_1","first-page":"168","article-title":"Botulinum toxin injection for facial wrinkles","volume":"90","author":"Small R","year":"2014","journal-title":"Am Fam Physician"},{"key":"e_1_2_13_4_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40268-014-0077-1"},{"issue":"11","key":"e_1_2_13_5_1","first-page":"1392","article-title":"Treatment of botulinum toxin\u2010induced eyelid ptosis with anticholinesterases","volume":"33","author":"Karami M","year":"2007","journal-title":"Dermatol Surg"},{"key":"e_1_2_13_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/jocd.13702"},{"key":"e_1_2_13_7_1","doi-asserted-by":"publisher","DOI":"10.3390\/toxins4100913"},{"key":"e_1_2_13_8_1","doi-asserted-by":"publisher","DOI":"10.2147\/CCID.S202919"},{"issue":"12","key":"e_1_2_13_9_1","first-page":"E1","article-title":"Management of ptosis","volume":"9","author":"King M","year":"2016","journal-title":"J Clin Aesthet Dermatol"},{"key":"e_1_2_13_10_1","unstructured":"Acquired Ptosis: Evaluation and Management.2005.https:\/\/www.aao.org\/eyenet\/article\/acquired\u2010ptosis\u2010evaluation\u2010management. 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