After Botox for crows feet, I got puffiness under my eyes that lasts for two weeks. What could be causing this? (Photo)

Question

I regularly receive Botox for crows feet and usually don't have problems. More recently, I've had persistent swelling under my eyes at the injection site for up to two weeks. Normally this area is completely flat and I have no normal bags under my eyes. Eventually it resolves but it take a long time and looks bad. It does not respond to icing or anything else. Is it muscle laxity? Irritation? Why does it only happen sometimes?

Steven F. Weiner, MD · Answer

What has happened is the lymphatic drainage around the eye has been impaired and it has accumulated in the malar fat pads. If the muscles are too relaxed, this can happened. The muscles pump the lymphatic fluid but if relaxed, they can no longer do that. In cases like yours, injections need to done higher and not come down as low on the crows feet. There is not much that can be done to make this better other than waiting it out.

Alex Eshaghian, MD, PhD · Answer

Thank you for your question and for sharing your photographs mtricher. I understand your concern. Botox is a purified protein used to address wrinkles associated with facial expression. When injected into the skin Botox will relax the muscles and smoothen out the overlying wrinkles. The most common areas of treatment are in the upper face. These include the horizontal lines seen on the upper forehead when one raises the brows, the vertical lines seen between the brows when one frowns (frown lines), and the crow's feet seen around the eyes when one smiles.
It is difficult to make an assessment in the absence of consistent photographs before and after in the same lighting and angles for comparison. However, I hope the information provided here is useful.The pivotal studies used 24 units of Botox (12 units per side) to address the crow’s feet. These studies demonstrated that the peak results are seen 14 days after the treatment and most people enjoy their results for 3-4 months. At that point, a maintenance treatment is recommended. While some people start to see results as early as the next day, it can take two weeks for full results so patience is important. We have our patients return two weeks after their treatment to assess their results via photographs. At that time additional units may be added if necessary. 
Some people have a deficit under the eyes due to loss of or downward movement of the fat pad in the tear trough area. In some cases, the muscle around the eyes serves to hold up the upper cheek fat pad. If this muscle is relaxed with Botox (as it is when addressing crow's feet), this volume deficit can be exaggerated. In these cases, restoring the lost volume with fillers such as Volbella or Vollure under the eyes or Voluma in the cheeks can correct the deficit. In other cases, the muscle around the eyes is used to push fluid into the lymphatic system. When relaxed with Botox this does not happen and a collection of fluid may be seen in the area. This is often more noticeable in the morning when waking up. Gentle massage of the area helps to relieve the buildup of fluid. When this happens, I recommend that my patient avoid treatment in the lower portion of the muscle in the future to avoid this issue.
If I had a patient with the concern described here I would recommend gentle massage and avoiding treatment of the lower crow's feet in the future.With any injection, there are risks such as pain, bleeding, bruising, redness, swelling, tenderness, and infection. We take special precautions to minimize these risks such as using a painless technique. We also treat bruises with a laser as early as the next day. Bruises usually resolve within two weeks if untreated. After a laser treatment bruises usually resolve in 1-3 days, but may still take two weeks for full resolution. In addition to these risks, with Botox there is also a risk that the product spreads or diffuses to nearby structures. Spread to nearby muscles can lead to side effects such as the temporary appearance of droopy eyelids or a temporary asymmetric smile.
  
After a Botox treatment, I recommend that my patients avoid heat exposure, alcohol consumption, and strenuous exercise for 24 hours and not lie down flat for four hours. This is because all of these activities may possibly lead to the movement of the product and consequent side effects such as droopy eyelids. Although there have been no definitive studies shown that these actually occur and some physicians do not provide such aftercare instructions, in the absence of data I err on the side of caution and recommend that my patients avoid such activities.
    
Please consult with a doctor for specific recommendations. Good luck!

Hardik Soni, MD · Answer

Thank you for your question. What is causing the bags under the eyes is that the lymphatic drainage around the eyes has been impaired and the muscles are unable to fully drain the lymph fluid.There is nothing you can do now until the Botox wears off in 3-4 months. Your injections need to be higher next so it does not cause this. I recommend contacting your treating physician and discussing your concerns.

Kristin J. Tarbet, MD, FACS · Answer

This will resolve with time. It appears your botox has affected the lymphatic drainage which is an atypical result but can happen.

Azad (Chandrashekhar) Singh, MBBS, MD · Answer

when muscle is paralysed it is obvious that lymphatic drainage is affected plus there is prominence of the malar fat now just wait and watch so that the effect of toxin is gone and everything is normal

After Botox for crows feet, I got puffiness under my eyes that lasts for two weeks. What could be causing this? (Photo)

Answers (7)

Answer: Botox puffiness

Answer: Botox puffiness

Answer: Botox After Effects

Answer: Botox After Effects

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After Botox for crows feet, I got puffiness under my eyes that lasts for two weeks. What could be causing this? (Photo)

Answers (7)

Answer: Botox puffiness

Answer: Botox puffiness

Answer: Botox After Effects

Answer: Botox After Effects

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Everything you need to know about Botox

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