Puffy and Drooping Eyelids After Botox

Eyelid droop can be corrected with a prescription eye drop (Iopidine 0.5%). This can help alleviate the droop within a few weeks to a month. You can also wait a couple of months for the effects of the Botox to wear off, at which point the droopiness will also go away.

While it is difficult to say based on post-injection and non-standardized photographs only, some eyelid puffiness or swelling can occur after Botox injections. When this occurs, it usually resolves over the next few days. 
More commonly, the issue is related to the brow position dropping somewhat and causing heaviness of the upper eyelid area. This is especially likely in patients with heavy upper eyelids, deep horizontal forehead wrinkles, and eyebrow position below the orbital rim prior to injections. These are all signs that the brow needs to be lifted into a higher position, or at least the Botox injections should be conservative in the forehead area and stronger in the glabella and crow's feet area to maintain the brow position.
Finally, ptosis (true eyelid droop) is possible with Botox injections, but this is less common and can be temporarily improved with prescription eye drops. This is due to Botox migrating into the muscles that open the upper eyelid.
Always see an expert physician injector.
All the best,

Eyelid drooping after neuromodulators like Botox, Dysport or Xeomin is a rare but well described issue, usually resulting from product placement or the amount used. 
The first thing that needs to be determined is whether it is a droopy eyebrow or truly a droopy eyelid. Droopy eyebrows are much more common and result from immobilizing the only muscle on the forehead that is able to lift up our eyebrows. Droopy eyelids come from the product getting into the wrong muscle that elevates the eyelid. 
Management of them is quite different, but both have strategies to help expedite resolution while waiting for them to resolve with time, and any experience injector should be very familiar with how to deal with them: drops for the eyelids and precise placement of Botox in the brow depressors when it is an eyebrow issue. 
To ensure you are receiving the highest level of care, seek out a modernly trained, new-school dermatologic surgeon, oculoplastic surgeon, facial plastic surgeon or plastic surgeon who is board certified and fellowship trained in one of these "core four" cosmetic specialties. Membership in organizations like the American Academy of Facial Plastic and Reconstructive Surgery help to identify a highly trained surgeon.
Cameron Chesnut#realself500 Physician

Thank you for your question. Sorry to hear about the droopy eyes. It sounds like you are experiencing ptosis of the eyelids and brows.  They eyelid portion can be partially corrected with the use of eye drops. Your physician would need to prescribe it. It will also wear off as the effect of Botox wears off.

Hello.  It's difficult to see from the photo how much eyelids because we don't have the "before" picture.  The good news is that because Botox is only temporary, the effects usually only last about 6-8 weeks.  

The condition is called ptosis and it occurs when the Botox is injected incorrectly in the forehead.  The product migrates to muscles that are not targeted.  The Botox relaxes these muscles and causes the eyelids to appear heavy or puffy.  Iopodine drops may help speed the resolution of the problem.  Ask your injector about them.

As for the crease that remains in between the eyes, it looks like you may need some dermal filler.  Your injector should have set the expectation that a deep furrow line like this might need Botox AND dermal fillers.  Good luck.

Thank you for your question! If it occurred immediately after the injections, then it is likely due to swelling or hematoma which will resolve over a few days to a few weeks, respectively. If it did not occur for 3 to 7 days after the injections, then you may have to wait several months .The full effect of the Botox typically lasts 3-4 months, and your hooding and puffiness may last that long. However upper eyelid drooping is temporary. The best news is that it will go away when Botox wears off, in several months. Best of luck!

Drooping eye lid can happen after botox however it may not be a true eyelid droop. I have explained the difference below for you and given some options for treatment. I also note you have a single stubborn line in the frown. If you cannot move the frown muscles then this line is a static line which will continue to improve with future botox use. If the frown is still mobile 2 weeks after treatment your doctor will assess the option for a top up at your review appointment. 
How to assess whether the eye lid has true ptosis.
True Ptosis happens when the eyelid itself drops to cover the eye. Even when the brow is raised the lid covers the eye. 
False Ptosis happens when the frontalis muscle is over treated. The frontalis muscle is an elevator of the brow. When this muscle is treated with botox it relaxes and stops pulling the brow up. The depressor muscles of the frown and crows feet pull the brow down. If these are not treated or if the frontalis muscle is very active and then suddenly deactivated the brow can put pressure on the eye lid and it's weight pulls the lid down.
There is an easy way to assess whether the eye lid is drooping due to true of false ptosis. 
By lifting the brows up (with fingers) the droopy eyelid should improve in false ptosis. If on lifting the brow the eye lid is still heavy and partially closed over the eye itself this is true ptosis.
Only in true ptosis can Iopidine drops help true. Iopidine will not help a heavy brow secondary to frontalis muscle inactivity ie false ptosis. 

There is no medication to recover a drop or ptosis. Time will allow the botox to wear off and increase muscle activity will lift the brow. If you have not had botox in the depressors (frown and crows feet / lateral brow) then this treatment will help release the brow and create a lift effect. 
Always best to return to your doctor if you are concerned. They will understand where the botox was placed and all of the options to correct or treat or leave be. 
I hope this helps. 

Thank you for your question and for sharing your
photograph. I am sorry to hear about your situation and I understand your concern. Botox is a purified protein
used to address wrinkles associated with facial expression. When injected into
the skin Botox will relax the muscles and smoothen out the overlying wrinkles. It is difficult to make an assessment in the
absence of consistent photographs before and after in the same lighting and
angles for comparison and without knowing the dose used and placement of
the product. However, I hope that the information provided here is helpful.The most common areas of treatment are in the upper face. These include the horizontal lines seen on the upper forehead when one raises the brows, the vertical lines seen between the brows when one frowns (frown lines), and the crow's feet seen around the eyes when one smiles. The appearance of frown lines is variable from
person to person. Usually they are in a vertical orientation but sometimes they
can be oblique and sometimes a horizontal line is seen across the upper portion
of the nasal bridge. The most common variation is to have two parallel lines,
hence the common term "11's" to describe them. But some people have
one, three, or more lines. Some people also will see a bulge in the area when
contracting the muscle. This bulge is smoothened out after a Botox treatment.Some people have lines at rest (that is without facial expression) which get deeper with facial expression. In these cases, the wrinkles often do not go away completely. However, I find that if patients continue treatments every three months as recommended the wrinkles smoothen out after approximately one year.The pivotal studies used 20 units of Botox in
the glabella area between the brow to address the frown lines. These studies
demonstrated that the peak results are seen 14 days after the treatment and
most people enjoy their results for 3-4 months. At that point, a maintenance
treatment is recommended. While some people start to see results as early as
the next day, it can take two weeks for full results so patience is
important. We have our patients return 2 weeks after their treatment to assess
their results via photographs. At that time additional units may be added if
necessary.Although 20 units is a good standard dose to
start with, some people require a higher dose because of higher muscle volume. This
is common in mature patients, in those with large bulges from expressive faces,
and in men. I find that Botox still works in these cases, just a higher dose is
required. I have used up to 40 units in the glabella.With any injection, there are risks such as
pain, bleeding, bruising, redness, swelling, tenderness, and infection. We take
special precautions to minimize these risks such as using a painless technique.
We also treat bruises with a laser as early as the next day. Bruises usually
resolve within 2 weeks if untreated. After a laser treatment bruises usually
resolve in 1-3 days, but may still take 2 weeks for full resolution. I recommend that my patients apply cold compresses such as ice packs and sleep on an extra pillow if not uncomfortable to reduce swelling.In addition to these risks, with Botox there is
also a risk that the product spreads or diffuses to nearby structures. Most
importantly are muscles required to perform various functions. The muscles that are treated with Botox around
the eyes are close to the muscle that lifts the upper eyelid. If this muscle is
affected it can lead to a temporary droopy eyelid (blepharoptosis). The
duration depends on the placement of the product and the dose used. Usually it
resolves in 2 weeks, but it can last up to 4 months. Blepharoptosis can be
treated with apraclonidine 0.5% ophthalmic solution (also known as iopidine)
and various other medications. For my patients, I recommend 2-3 drops to the
affected eye 2-3 times per day. When the blepharoptosis begins to wear off
patients notice less of a droop when waking up in the morning after the last
dose of apraclonidine has worn off. The incidence of blepharoptosis is reported
to be approximately 1% but in my experience, I find it to be about 0.1%. This
is likely due to the fact that when these studies were initially performed
injectors may have not been as aware of this adverse effect nor been taking
extra precautions to avoid it.Blepharoptosis occurs when Botox is placed near
the eye and it diffuses to the muscle that lifts the upper eyelid (levator
palpebrae superioris). This is located inside of the orbital rim above the
globe. To avoid this side effect, I place the product at least 1 cm from the
orbital rim. When placing product between the brows I pinch the area to be
treated and lift it so that the product is placed in the muscle and is less
likely to diffuse around the bone into the orbital space. Diffusion into this
area may also be caused by other preventable things. For this reason, I
recommend that my patients follow the aftercare instructions below. This may be a reason for the low incidence of side effects in
my practice.After a Botox treatment, I recommend that my
patients avoid heat exposure, alcohol consumption, and strenuous exercise for
24 hours and not lie down flat for 4 hours. This is because all of these
activities may possibly lead to the movement of the product and consequent side
effects such as droopy eyelids as described above. Although there have been no
definitive studies shown that these actually occur and some physicians do not
provide such aftercare instructions, in the absence of data I err on the side
of caution and recommend that my patients avoid such activities.Botox is what we call a neuromodulator. This
means that it controls nerves to prevent the muscles from contracting. Botox is
the most popular neuromodulator available, has been the most studied, and is
cleared for the most number of indications. Other neuromodulators available in
the United States include Dysport, Xeomin, and Mybloc. Overseas many others are
also available. Each product has slight differences, but all of them work. The
majority of our patients find that they like the results of Botox the best.
Additionally, Allergan, the maker of Botox, offers the Brilliant Distinctions
Program. This is a rewards program where patients receive points from their
Botox treatments which can be used toward discounts at subsequent treatments.
Points are also received when patients purchase other treatments in the
Allergan portfolio including Juvederm Ultra, Juvederm Ultra Plus, Voluma,
Volbella, Vollure, and Kybella or products such as Latisse or Skin Medica
products.I find that combining Botox with other
treatments or skin care regimens enhances the results and allows patients to
enjoy their results for longer. One specific topical product our patients have
found to be outstanding in conjunction with a Botox (and filler) treatment is
our Hydrating Serum, which contains hyaluronic acid. Hyaluronic acid draws water
into the skin and helps to fill in fine lines and wrinkles.Please consult with a doctor for specific
recommendations. Good luck!

If it occurred immediately after the injections, then it is likely due to swelling or hematoma which will resolve over a few days to a few weeks, respectively. If it did not occur for 3 to 7 days after the injections, then you may have to wait several months .The full effect of the Botox typically lasts 3-4 months, and your hooding and puffiness may last that long. However upper eyelid drooping is temporary. The best news is that it will go away when Botox wears off, in several months.

The puffy and drooping lids you are noting are seen when your injector places Botox in the frontalis muscles.  Some people may be more sensitive to being injected in this area and experience flattening of the wrinkles in the forehead  but an inability to lift the forehead causing this perceived droop.  Wait for this to wear off and then tell your next injector that you did not like your forehead injected too low.