Peter Kally, MD, FACS

Regarding your fine lines and wrinkles on the inner corners of your eyelids, botox would not well address or treat these areas based on your concern and photo. My recommendation is for laser resurfacing around your eyelids. This can be performed with a variety of skin-lasers although the most common are generally CO2 or Erbium based. Your local oculoplastic or facial plastic surgeon would be able to better evaluate and treat your specific goals after a full examination of your facial movement.

I must commend your surgeons, for the duration of time you have had this implant it appears to have held up very well. Volume loss in the upper lid (superior sulcus syndrome) is very common in these procedures. There are many techniques to augment the lost volume in the socket, with both non-surgical options such as prosthetic adjustment, filler, or fat injection. There are also surgical treatments to adjust the lid height, implant position and volume, or transfer additional fat volume to the socket. An evaluation from your local oculofacial plastic surgeon would be able to determine the best approach for your unique situation.

The general post-procedural care from Botox injection is to limit migration, bruising, and irritation. For these reasons, patients are asked to limit strenuous (sweating) exercise, alcohol or spicy foods (which cause vasodilation), or hot shower/sauna use for 24 hours. I would apply this same principle for heated eye mask use. Additionally, avoid massaging the area or lying down for the first 4 hours after injection, and avoid sleeping on your face the first night. This is not a comprehensive list and some patients have specific restrictions. It is important a skilled injector such as your local oculofacial plastic surgeon perform a comprehensive evaluation to safely meet your goals.

To answer your concern about periorbital muscle atrophy with chronic Botox use: Yes, there is a risk of muscle atrophy with prolonged and frequent neurotoxin use. A skilled injector will be able to limit your risks by only performing treatments when needed and at the proper frequency/dose. Around the eyes, your orbicularis muscle is used frequently for spontaneous blink and forced eye closure as well as for facial expression. The counter to any noted atrophy is stopping neurotoxin use and continuing to live your life, the normal and frequent use of this muscle will allow it to hypertrophy the atrophied fibers. A consistent injector such as an oculofacial plastic surgeon will be able to monitor treatment effect and adjust dose or frequency to limit side effects.

Regarding use of Botox while taking blood thinners: Blood thinner use will increase your chance of bleeding/bruising during the injection and I recommend a skilled injector perform your treatment since there are additional techniques that can mitigate your risk. The primary use of botox is intramuscular use. When injected correctly into the muscle, it is not placed in the vessels and therefore not intended to disseminate around the body. The risk of intravascular injection is the same as when not on blood thinners, and a reason I recommend a trained injector perform your treatments. Facial plastic and oculofacial plastic surgeons can provide a thorough evaluation and treatment to fit your individual situation.