Puffy hooded eyes after Botox? How can I avoid this next time? (photos)

Question

I had 8 units on the upper (4 injection sites)1/3 of forehead and 10 units in the glabella. My eyes look completely different now. They are less round and more squinted. One eye has even dropped a little. How can I avoid this next time? Should I avoid the forehead units all together and just get the glabella treated? I miss my old eyes! I’ve attached photos!

George Yang, MD · Answer

Hi Tayloor,
On your before photos, you have deep set eyes which you like.  The 1 week after photo show a fuller, puffier brow which you do not like.  At 3 weeks, it is beginning to become more hollowed again perhaps as the swelling goes away.
The injections between the eyebrows can cause swelling around the brow area which may have given you the puffy brow. 
Your 3 week photo perhaps was in the morning, but I can see a bit of hollowing returning.
If you take a selfie in the evening I think you will see it looks more like your before photo, than a selfie taken first thing in the morning.
In general the forehead Botox should keep your eyebrows low which should keep your eyes more like your before Botox appearance.  Perhaps the swelling around the eyes from the injections was making you raise your eyebrows instead of relaxing them when you are not puffy. 
I don’t think you will need to wait for the Botox to wear off to get your old eyes back.  Waiting for the swelling to go away should get you back, I hope.  Good luck.
Please post a follow up to let us know you are doing better.

Best, 
 Dr. Yang 
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Nelson Castillo, MD · Answer

Thank you for sharing your question and photographs.  Treatment of the forehead with Botox will have a tendency of lowering one's brows, while treatment of the glabella and crows feet will tend to elevate it.  Injector experience then figures the appropriate injection pattern and unit amount to effect this tug-of-war to give the best results.  Although your appearance will be completely restored once the Botox wears off I would alert your injector to your negative side effects so that they can adjust accordingly.

Michelle Ellern, DO · Answer

If you have too much brown drooping I would minimize or eliminate treating the forehead. You can follow up with your injector to see if they can do anything to get a little lift for now. Good luck.

Leonard Grossman, MD · Answer

Botox should be used only when there are proper indications for the use of it. In people who use botox just because, problems can occur. Your undesirable effect of Botox will diminish within a few months and most likely you will get back your preferred appearance. I hope this helps and good luck from New York City

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