Why did Botox around my eyes worsen my wrinkles? (photos)

I got botox for the first time two days ago. I went to a board certified dermatologist. I wanted to reduce my under eye wrinkles and crows feet. She gave me 25 injections total on both eyes. I now look horrible when I smile. I now have deep hollows and puffy wrinkles under my eyes that weren't there before the injections. Is this normal? Did the doctor inject too much or in the wrong places to cause this?

Doctor Answers 7

Botox under eyes

It has only been 2 days since you have had it done, and it can take up to 14 days to see full results. When you go to your 2 week check up, you can discuss your appearance and concerns with your dermatologist. Best of luck!

Botox results

Botox usually takes 7-14 days for full result. It is almost certainly too early to judge your results. The photos demonstrate crow's feet and undereye lines which will likely improve once the Botox takes effect. Hang in there and followup with your injector at the two week mark if you are still not satisfied.

It can take up to two weeks to see full Botox results

Thank you for your question EllPe. Botox is a purified protein used to address wrinkles associated with facial expression such as the crows feet around the eyes seen when one smiles or squints. Most people see the results of their Botox treatment 3-7 days after the treatment. But it could take up to 2 weeks for full results. In our office we have patients return two weeks after their treatments to take after photographs and assess the results. Please follow up with your doctor for specific recommendations. Good luck!

Alex Eshaghian, MD, PhD
Encino Physician
5.0 out of 5 stars 1 review

Why did Botox around my eyes worsen my wrinkles?

Thanks for bringing up your concern, and sorry to hear about situation.  If it has only been 2 days then it has not been enough time to make a final judgment on how well the Botox will help smooth mourned your eyes.  It can take up to a few weeks to get to the final result.  As an oculofacial plastic surgeon, I have injected around the eyes for close to 20 years and usually don't see what you are describing.  However, I have to for some of my medical patients (blepharospasm) inject very close to the eyelid margin.  There are some injectors for good reasons that don't inject as close to the eye because the risks of double vision and worsening dryness of the eyes can occur.  Not knowing the dosing, the exact injection pattern, the formulation of botulinum used, or the strength of your particular muscles it makes it very hard to comment at this point after your injections if this will be a long-term (few months) issue or if at a few weeks it will smooth out like you were hoping.  I would talk to you injector about your concerns when it has been a couple of weeks.  Best regards, and don't give up.  Botox around the eyes can provide wonderful results under most circumstances, but its not for everyone.  Please be aware that when you smile you will always have some wrinkles under the eyes as the lower facial muscles pull/push up the skin around the eyes causing strong expression lines when smiling strongly.

John R. Burroughs, MD
Colorado Springs Oculoplastic Surgeon
5.0 out of 5 stars 14 reviews

Crows feet Botox

I have a love hate relationship with Botox for my crows feet for the exact reason you have posted your question.  Since the muscle around the eyelids is circular, and the FDA recommended dosage is only in the outer part of the muscle, some people experience increased wrinkling underneath the eyelid after the outer part of the muscle is injected. This can be fixed by injecting smaller amounts of Botox directly into the muscle underneath the eye. However, this can make it feel funny when you try to squeeze your eyes tightly shut, and it can change the look of your smile.  If you get the right amounts you may love it. It may be difficult to get the amount right, and you may choose to undergo laser  as an alternative for under eye wrinkles and crows feet instead of using Botox in the future. Good luck. 

Dana Goldberg, MD
Jupiter Plastic Surgeon
5.0 out of 5 stars 31 reviews

Botox Wrinkles

In general Botox does not take effect for 5 - 7 days and even up until two weeks until it has its maximal effect. You should give the Botox time to start working and if the wrinkles have not improved in two weeks you can usually treat persistent areas with some touch-up injections.

Anthony J. Wilson, MD
Portsmouth Physician
5.0 out of 5 stars 5 reviews

Botox and undereye changes

Botox generally takes 10-14 days to completely kick in. Changes will continue to occur up until this time. There is a good chance not enough time has elapsed for you to see the outcome of your injections. If the lines around the eyes and the puffiness of the under eyes does not improve after 10-14 days, it could be related to your injections. Botox injections to improve fine lines and wrinkles around the eyes (otherwise known as crows feet) require appropriate placement and dosing for softening and improving these lines. If a patient has existing laxity (loose skin) under the eyes, Botox can make this appear to be worse as the muscle is no longer able contract in that area.

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.