Puckering, bunching amd more wrinkles after under eye injected with Botox as part of crows feet remedy. 3 days post op. (photos)

Question

Hello, I had Botox injected 72 hours ago for crows feet. I have had Botox for crows feet many times before without a problem. However, this time I was injected under the eye. A small pocket and extra creasing and puckering has appeared. I sent a photo to the injector who recommended waiting the full 2 weeks and then if it hasn’t resolved she will touch up the newly wrinkled area with Botox “into the skin, not muscle, to relax the wrinkle”. Any advice would be greatly appreciated. Many thanks!

Melissa Chiang, MD, FAAD · Answer

I am sorry that you are going through this.  I agree that you should wait until the neurotoxin takes full effect.  Sometimes there is a "transition" period, which evens out.  I also think it is important to go to an experienced injector, preferably a board-certified physician in derm or plastics.

Christopher J. Davidson, MD, FACS · Answer

Thank you for your question.  My strong advice is to wait a full week before considering the final result of your Botox treatment.  You may have some swelling that will resolve on it's own.  Best of luck.

Dean P. Kane, MD, FACS · Answer

Dear sazzy2016:So sorry for your troubles! Thanks for sharing your photos.What I see is a hollowing of the tissues under the eye, elongation of the lower eyelid / cheek junction and a lack of orbicularis oculi muscle tightening with (it appears) rounding of the eyelid near the nose. I wonder if you are tearing more in this eye and your nasolabial fold and upper lip did not also "fall"? Botox is an injectable muscle weakener and when properly placed will rebalance the pull of the skin by the muscles of facial expression. When your upper lateral "crow's feet crease" muscles were injected previously, your lateral brow should have risen. Unfortunately, it appears that the injection caused the lower lid muscle to temporarily weaken. This relaxed the eyelid creating more rounding of eyelid margin, pulling away from the globe, weakening  the "push-back" of the fat compartments (ie., the pockets), decreasing the ability to drain tears as well as having gravity pull on the laxed skin causing the creasing. Should the injection have reached the deeper cheek muscle(s), your nasolabial fold and upper lip will descend as well. Please do not inject more Botox into the passive "creases". This will only worsen the problem. Botox will "wear off" in an average of 3 months. You may try stimulating the brain to hasten the formation of nerve connections to the muscle with exercises by holding the opposite cheek in place and trying to smile and close the weaker cheek and eye 3 times daily for a minute. You may also obtain a TENS unit at the pharmacy or Amazon to electrically stimulate the muscles to contract and send a signal to the brain as well. Please obtain consultation from an Board Certified Ophthalmologist for instructions and if you develop dry or gritty eye or irritation and inflammation in the meantime. Consult a Board Certified Plastic Surgeon with the skills and experience to properly inject Botox. Happy Holidays! I wish you the best!

Leonard Grossman, MD · Answer

It is too soon to make any kind of judgment call or attempt to do anything else after just 72 hours following you treatment. You should give yourself at least one week following the Botox treatment to see what needs to be done. Good luck from New York City

Puckering, bunching amd more wrinkles after under eye injected with Botox as part of crows feet remedy. 3 days post op. (photos)

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