Should I be worried about this heaviness and puffy eyes after Botox? (photo)

Question

I don’t know if I’m paranoid but I was wondering if someone could look at this picture of me post Botox. I had it two days ago with a different nurse who convinced me to have a lot more than I usually do for my frown lines. She objected around the brow, the forehead and one under each eyebrow. I’m not sure how many units but there were a lot more injection sites than previously. My face feels swollen, heavy and odd.

Benjamin Caughlin, MD, FACS · Answer

Please watch the video below. I try to explain some key aspects of the technicalities of using or getting botox. It really does make a difference who is injecting, how much and where it is injected. It is one of those treatments that unfortunately has become a commodity and it really requires a bit more of an artistic finesse approach ini my mind.  
We use the neuromodulators to target and soften the muscle groups without giving that frozen look. 
Hope this helps,
Best of luck,
DrC

Monika Soni, MD · Answer

It is hard to tell without a pre photo. However, it is very important to have a skilled injector who performs the procedure. I would follow up with that nurse and learn just exactly how many units were injected and which areas. Best of luck

Ryan Welter, MD · Answer

Thank you for your question and photograph.  Without a pre-procedure photograph, it is difficult to comment on your result.  That being said, since you are experiencing feelings of heaviness and puffiness, my advice is to follow-up with your injector for an evaluation and documentation of your result.  Best of luck.

Lisa Freeman, MBBS · Answer

Hi Natasha,
There is no need to be worried as anti wrinkle injections are only temporary. Without a pre botox photo it is difficult to comment on your photo. The heavy feeling can be from injecting too many units plus/minus injecting too low on your forehead compared to your previous injector. If it was only 2 days ago, the blocking of the forehead frontalis muscle may also have started working before the other muscles have, and so the heaviness may settle over the next 2 weeks. If not it would be a good idea to go back to your injector.
 Kind regards,

J. Timothy Heffernan, MD · Answer

Thank you for your question. It is hard to tell without a pre photo. However, it is very important to have a skilled injector who performs the procedure. I would follow up with that nurse and learn just exactly how many units were injected and which areas. Best of luck, Dr. Heffernan

Aric Aghayan, MD · Answer

Dear natashafostersyd,It is difficult to tell from a single photo, but you don't have obvious asymmetry, drooping of your brow, or drooping of your eyelids. I would give it a few days to let the full botox effect set in, but I don't see any obvious complications. Although they can be annoying, the effects of the botox will wear off in a few months. Make sure to see an experienced dermatologist, plastic surgeon, or facial plastic surgeon for your injections to avoid complications. Take care.

Sheryl D. Clark, MD, FAAD · Answer

Dear natashafostersyd:When injecting the frontalis  muscle, especially in larger doses, at the same time as the glabellar complex between and above the brows, it is possible for the frontalis muscle, which is thinner and broader, to be relaxed before Botox of the thicker muscles of the glabella right complex takes effect. In this case the problem sometimes improves after a few days. It is also possible for the relaxation of the frontalis muscle to allow the brows to drop and to give your upper eyelids a heavy, puffy look.  If your forehead feels frozen this is likely what has happened. Unfortunately, unless you can still make a frown between your brows, there is nothing that will lift your brows up again other than tincture of time.I would recommend to any patient, just as I would to my sister, that you seek Botox treatment from a board-certified advanced injector who is a dermatologist or plastic surgeon. There really is an art to planning and performing the treatment, and extensive experience as well as intimate knowledge of the anatomy (for example, through anatomic dissection in Medical School and surgical experience) to understand how muscles appose and work together and the depth and location as well as the concentration and number of units for the optimal results. Wishing you all the best!Dr. Clark

Chester F. Griffiths, MD, FACS - Account Suspended · Answer

Hello and thank you for your question.
This can happen from an allergic response, poor technique or wrong injection site (under the eye brow is not a common site), and/or excessive amounts used. Express your concerns with the Nurse that performed the treatment and learn exactly how much was used for each location so you may avoid this dosage in the future- whether you continue with her or another Provider. An example would be lowering the amount of units used on the frontalis muscle, as excessive botox to this muscle may drop the brows leading to an uncomfortable experience. 
Best,
Chester Griffiths, MD, FACS

Should I be worried about this heaviness and puffy eyes after Botox? (photo)

Answers (8)

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