Can Botox Cause Eyelid Puffiness?

Question

I had Botox done to reduce my "stress wrinkle" between my eyebrows and my forehead lines about two weeks ago. The results for me were far beyond typical and I am thrilled - the wrinkles are GONE - except now, my eyelids have seemed more "puffy" than normal. It is not swelling or a "droop"- yet the area just over the brow bone seems thicker and heavier. Is this normal? Will it lessen or can I expect the same result each time?

Otto Joseph Placik, MD · Answer

I have had many patients complain about temporary brow swelling two weeks after experiencing their first Botox injections.
In the vast majority of cases this has resolved and does not recur after repeated injections.
It is my own opinion that this may be due to the altered circulation with cessation of muscle use that typically directs the fluid drainage of the face.
Typically this will be worse in the morning and improve throughout the day.
This has tended to improve by one month after the initial injection

Mark K. Markarian, MD, MSPH, FACS · Answer

Short answer -- they puffiness you are experiencing is likely due to the gathering of skin above your eyelid from the drooping eye-BROW caused by your Botox treatment.  This will likely last 3-4 months as the Botox wears off...A drooping eye-BROW may be encountered after Botox treatment when the brow-elevating muscle in the forehead, the Frontalis, receives too high a dose of Botox, or alternatively, if the Botox is sub-optimally placed too low in the forehead. However, in some cases, a patient may have a low set eyebrow to begin with, so if he/she were to receive any Botox to the forehead, this would increase the likelihood of a brow droop. Regardless, a droopy eyebrow can sometimes be improved with Botox injected into the outside part of the eye (the lateral aspect of the orbicularis oculi muscle) to generate a bit of a brow lift in that area -- by injecting Botox and paralyzing the orbicularis muscle that normally acts to depress the brow in that area, you may get a slight compensatory brow lift...My overall recommendations are to seek the services of an experienced physician injector. I think the key with Botox lies in truly understanding the anatomy of the injected area, and more importantly the variability in the anatomy between patients -- for brows, the forehead, and anywhere else you plan on receiving a Botox injection. This includes having a firm understanding of the origin, insertion, and action of each muscle that will be injected, the thickness of each muscle targeted, how deep beneath the skin the actual muscle resides, and the patient variability therein. As an aesthetic-trained plastic surgeon, I am intrinsically biased since I operate in the area for browlifts and facelifts, and have a unique perspective to the muscle anatomy since I commonly dissect under the skin, see the actual muscles themselves, and learn "first-hand" the incredible variability between patients -- live, "on the OR table" -- as opposed to via lectures or a cadaver dissection. For me, this helps guide where to inject and where not to. However, with that said, I know many other physicians who know the anatomy well despite not operating in that area, and get good results.Good luck.Dr Markarian

Harold J. Kaplan, MD · Answer

It's unlikely that you still have swelling from a Botox injections two weeks after the fact.  Is the swelling also accompanied by redness or tenderness? If so, this may be an indication of an infection that needs to be looked at.
If there is no redness or swelling, it is more likely that this is "ptosis" or a drooping of the eyelids. This droopiness can often appear as heaviness or swelling. In either case, we would recommend you visit your injector for an evaluation.

Sergio Pasquale Maggi, MD, FACS · Answer

Dear Heather W from Sav, GA,
 It appears from your question that you have recently had your Botox treatment, and that this is your initial experience.  I am glad you are "thrilled" with the result.  As you found out it typically takes 5 to 7 days to see the effect on the area from the Botox.
Without seeing the area the "puffiness" you describe just below the area treated sounds as some mild/residual swelling from the injections to the area. 
Depending on the number of injections, the size of the needle, and the amount of bruising you had after the treatment some degree of swelling is common.  As the swelling resolves the final stages appear as residual 'puffiness' in the area below, or dependent, from the treatment.  This also should resolve. 
But if the area is red, and/or tender, or not improving, you may want to have your physician evaluate the area for an infection or other complication from the procedure.
I hope this helped answer your question.
Best wishes,
S.P. Maggi, M.D., FACS

Kris M. Reddy, MD, FACS · Answer

Without photos, it is difficult to assess what is going on.  It may just be some residual swelling.  It may be from improper technique. I would contact the physician's office to ease your mind.

Can Botox Cause Eyelid Puffiness?

Answers (7)

Answer: Some swelling, or puffiness, can develop after the injections.

Answer: Some swelling, or puffiness, can develop after the injections.

Answer: Botox and Puffiness

Answer: Botox and Puffiness

Recommended reading

Everything you need to know about Botox

Our mission is to create a world where every investment in modern beauty is Worth It.

Can Botox Cause Eyelid Puffiness?

Answers (7)

Answer: Some swelling, or puffiness, can develop after the injections.

Answer: Some swelling, or puffiness, can develop after the injections.

Answer: Botox and Puffiness

Answer: Botox and Puffiness

Browse related questions

Recommended reading

Everything you need to know about Botox

Our mission is to create a world where every investment in modern beauty is Worth It.