A lower eyelid botox injection caused pain and bleeding. Is this normal or should I be worried?

Question

I had lower botox injections in both eyes. Something went wrong and my eyelids won't close fully. Three months later the right is recovering slowly but I haven't seen any change in the left. When the left one was done it hurt and bled. I am worried it hit a nerve or did some permanent damage, is that possible?

Andrew Campbell, MD · Answer

I'm so sorry to hear that you are having problems after Botox. Botox is historically an extremely safe and reliable treatment. The problems you are having should completely resolve if they are from the Botox. Botox can not cause a permanent issue. I'd highly recommend you speak with your injector about this and consider seeing an eyelid specialist.Andrew Campbell, M.D.Facial Rejuvenation SpecialistQuintessa Aesthetic Centers

Jason Emer, MD · Answer

Some bleeding can be normal after an injection. Botox usually dissolves in 3-4 months, so this will likely resolve.  I suggest speaking to a Dr. about your concerns.  Best, Dr. Emer.

Mary P. Lupo, MD · Answer

I am wondering if you are on blood thinners since such bleeding is not usual from Botox, especially under the eye, where the injection is done just under the skin. And it sounds like the muscle was weakened too much from a heavy dose, causing ectropion. I would check with an oculoplastic surgeon for this unusual complication.

Kristin J. Tarbet, MD, FACS · Answer

The good news in your situation is that Botox wears off over time. It sounds like you had some bleeding with your injection which happens from time to time. I would follow up with you injector for a recheck and to discuss your concerns.

Pamela Stuart, MD · Answer

It may be likely that the Botox may have caused the lower lid drooping. You should speak with your physician to allow them to work with you as this resolves. Remember to keep your eyes moist with artificial tear drops, if you are experiencing any dryness due to this as well.

Corey Frucht, MD, PhD · Answer

Hello, and thanks for your question. I'm sorry to hear you've had trouble. Botox can take up to 4 months to wear off, so it may still take more time. If you are still having trouble in a month, I recommend following up with your physician. Best of luck, Dr. Frucht.

Melvin Elson, MD · Answer

it is unusual to have this much difficulty at this point but it will not be permanent and should resolve without any treatment.  the bleeding (bruise) was caused by the needle puncturing a vein and will heal. the other symptoms are simply related to the action of Botox on the nerves and will also clear completely

Alex Eshaghian, MD, PhD · Answer

Thank you for your question glidi67. I am sorry
to hear about your situation. Botox is a purified protein used to address
wrinkles associated with facial expressions. Botox can be placed just below the eyes. This helps open the eyes slightly. A small amount must be used otherwise it may become difficult to close the eyes and the eyes can subsequently become dry. Bleeding is a possible side effect with any injection. I have never seen permanent nerve damage with Botox. Please follow up with your doctor for
specific recommendations. Good luck!

Steven F. Weiner, MD · Answer

It sounds like either too much Botox was used or you were not a candidate for this injection. You must pass a snap test prior to injection in this area. Everything should reverse to baseline within about 4 months. Don't worry. Nerve damage doesn't occur with these injections.

Samuel Siddiqui, MD · Answer

Injections of Botox under the eye can frequently produce mild bruising as the tissues below are highly vascularized.  There should not any pain post procedure.  A bruise that lasts for several days post procedure before disappearing is not unusual.  Incomplete closure of the eye is not a common adverse effect in my observation.  Incompete closure of the eye carries a major risk for corneal abrasion and infection.  I suggest to return to the doctor who performed the procedure for further assessment.  Best wishes.

A lower eyelid botox injection caused pain and bleeding. Is this normal or should I be worried?

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