Can Botox-Induced Pseudoherniation Be Resolved?

Question

I had Botox to treat crows feet 3 months ago and ended up with a pseudoherniation of the orbital fat pad under my left eye. I've reviewed questions about this problem, and doctors responses, on realself. Consistent with other, I have had creping of the skin for both eyes & the botox injection for the this eye was toward the middle of the under eye. While the creping has improved slightly since I started to get some movement back, the pseudoherniation persists. I know doctors have said it should pass (in theory), but can you tell me if you have seen a patient with a botox-induced psuedohernaition that has resolved.

Ron Shelton, MD · Answer

if there is a fat pad herniation from age, it needs surgery to fix it. If the muscle is weakened and the eyelid fat pad does not penetrate the muscle, but it pushes the muscle wall out, then that is a pseudoherniation which should resolve itself as the botox wears off in four months or less. If it doesn't, please see a plastic or oculoplastic surgeon.

Kenneth D. Steinsapir, MD · Answer

Will your lower eyelids look better as your BOTOX for the lower eyelids wears off? Not necessarily. First, if your injector is not taking before and after photos in association with your treatment, you are getting care in the wrong place. I suspect that you BOTOX treatment could make this a little worse. But I also under if you have an issue that is unrelated to the BOTOX treatment. A personal consultation with a real eyelid surgeon is what you need. You may need lower eyelid surgery.

Will Richardson, MD · Answer

I cannot stress the importance of the pinch test to asses the elasticity of the lower eyelid skin.  If when you pinch the skin there is minimal return to normal position, then periocular Botox is not for you.

Madeline Krauss, MD · Answer

I have seen this complication twice, and it has always resolved in about a 4 month period. I would avoid Botox in the lower lid again. If you choose to have the crows feet treated in the future, ask the dermatologist or plastic surgeon to stay away from the lower lid to avoid this while still improving the lateral eye area.

Eugene Mandrea, MD (retired) · Answer

If the creepiness and pseudoherniation is indeed caused by the Botox, it will subside within 3-4 months, or maximum 6 months
If  it doesn't disappear, there are 3 office procedure treatments: eyes by Thermage or Laser  resurfacing (traditional) or Fractionated laser resurfacing. Or, failing those, an invasive procedure: Blepharoplasty.
Always make sure that you are treated by a Board certified  Dermatologist or Plastic Surgeon.

Can Botox-Induced Pseudoherniation Be Resolved?

Answers (6)