I've Been Using Botox for Four Years Now and As I Look at my Eyes, They Seem to Look Smaller and Smaller. Why is This?

Also, I've noticed my already hooded eyelids look even heavier...I really believe this has something to do with the injections. But why?

Doctor Answers 15

Eyes Smaller after Botox

Consider lifting eye brows and minimize dosage on forehead will help make the eyes look better.  Consider skin tightening (ThermiSmooth)  or surgery if eye is getting smaller due 
to excess skin. 

San Mateo OB/GYN
5.0 out of 5 stars 4 reviews

Paralyzing the forehead with botox can cause eyes to look hooded and smaller

If you use your forehead to keep your eyebrows up and your eyelids open, paralyzing the forehead with botox can result in the upper eyelids appearing heavy or more hooded.  An experienced injector will look at your natural facial movements/structure and accommodate for this.  

Of note, you can also use botox to open the eye and bring the brow up.  This is done by injecting botox into the muscle around the eye, called obicularis oculi, near the outer edge of the eyebrow.

Melissa Chiang, MD, FAAD
Houston Dermatologic Surgeon
5.0 out of 5 stars 12 reviews

Too much Botox can cause heaviness of brows

Overtreatment of the frontalis muscle in the forehead can cause brow heaviness and upper eyelid hooding that may appear to make the eyes look smaller.  Thoughtful placement of the Botox (using small amounts) in the forehead, glabella, and lateral brow, and lower eyelid can often "widen" the appearance of the eyes.  

Aging is a dynamic process.  Part of what you are describing may be due to volume loss.  Volumizing agents and/or fat may be able to address some of the changes you describe.

Melanie D. Palm, MD
San Diego Dermatologic Surgeon
4.9 out of 5 stars 23 reviews

Effects of aging

Most likely you are seeing the effects of aging and routine brow ptosis (droop). Any ptosis or droop from Botox would be transient and resolve after a few months.

Richard Galitz, MD, FACS
Miami Facial Plastic Surgeon
4.6 out of 5 stars 11 reviews

Eyes looking smaller after botox

It would be very helpful to look at your pictures (and pictures of your eyes from years ago).  Most likely you are referring to the aging process as your brows descend over time, your eyes start to look heavy, your upper eyelids seem fuller.  But once again, without pictures, this is just a speculation.
Martin Jugenburg, MD

Martin Jugenburg, MD
Toronto Plastic Surgeon
4.9 out of 5 stars 457 reviews

My Eyes Look Smaller after Botox?

Hi TO.  There is more than one explanation, but without photos it's difficult to say what is happening.  

One answer is that this is just part of the natural aging process.  As we age, gravity pulls our facial features downward.  This may be happening naturally with your brow, which puts more downward pressure on the lids, which can make the eye appear smaller - less of it is visible.  As we age, the skin on the upper eyelid becomes less elastic.  This excess tissue can also make your eyes appear smaller.

Alternatively, the ongoing Botox injections, because they can relax the forehead muscles, may have contributed to the facial structure being slightly lower.  This can have the same affect as the natural again process described above.  

Finally , if your injector is using too much Botox in the forehead, he could be dropping your brow with each injection.  Again, before and after pictures would help.  

It may be time to consider a Botox browlift, surgical browlift and/or blepharoplasty (eye surgery) as another option.

Harold J. Kaplan, MD
Los Angeles Facial Plastic Surgeon
4.3 out of 5 stars 6 reviews

The botox weakens the frontalis muscle.

The frontalis muscle is the main elevator of the eyebrows.  BOTOX treatment in the forehead weakens this muscle.  This means the forehead relaxed and the eyebrow fall.  The upper eyelid fold gets heavier as this muscle relaxed.  

Kenneth D. Steinsapir, MD
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

Lids smaller after botox.

You probably are getting some descent from aging which is being exaggerated by the Botox lowering your brow a little. I suggest you reevaluate after the Botox has completely worn off. You may need a lid or brow procedure at this time.

Michael L. Schwartz, MD
West Palm Beach Facial Plastic Surgeon
4.8 out of 5 stars 12 reviews

Botox does make eyes smaller

You need to loo at the older pictures and compare them to pictures now. the eyes will age like other parts of the face. The best thing would be to get a consultation with a board certified plastic surgeon.

Kamran Khoobehi, MD
New Orleans Plastic Surgeon
4.8 out of 5 stars 122 reviews

I've Been Using Botox for Four Years Now and As I Look at my Eyes, They Seem to Look Smaller and Smaller. Why is This?

 I have used neurotoxins like Botox, Dysport and the newer Xemonin,for over 20 years to soften unwanted lines and wrinkles.   Without photos of your eyes then and now I'd have to guess that it's an increase in upper eyelid fullness that's causing this apperance.  This may be from repeated Botox too close to the eyebrows causing them to drop or may be related to an actual increase in excess upper eyelid skin.

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.6 out of 5 stars 24 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.