Botox in lower eyelid for opening/widening (larger looking) eyes. (Photo)

Question

My eyes are not particularly small but I would love a more open, wider effect. I think this is beautiful. I have read that Botox under each eye can relax the lower lid to give the eye a larger/wider appearance. I regularly get Botox in my forehead & glabella, sometimes do it around the brow for a lift (which I love) and have done around the crows feet (which was ok). Am I possibly a good candidate for Botox in the lower lid for a larger appearance of the eyes?

Jacob Sedgh, MD · Answer

Strategic placement of Botox can have a subtle effect on increasing the distance between the upper and lower eyelid margins (more opening of the eye) at the expense of transient weakness of lower eyelid muscles. In younger patients with tight lower eyelids and no significant issues with laxity or fat protrusion, this can be tolerated well. However, in older patients with above issues, there might be some concerns and a thorough examination is key before deciding on the candidacy.

Trevor M. Born, MD · Answer

Dear skcrossleyThank you for your question and photo!  Botox would be helpful for shaping your lower eyelid.  The caution is if you have any fat protrusion - this could be made worse and not reversible.With Warm RegardsTrevor M Born MD

Nelson Castillo, MD · Answer

Thank you for sharing your question and photograph. Based on your current appearance I do not think Botox in the lower eye lid will accomplish what you are interested in.  With the lack of a thickened muscle Botox will offer little improvement and may cause unexpected changes. Hope this helps

Shaun Patel, MD · Answer

Yes, Botox can be injected into the undereye to open up the eyes and to soften the appearance of the pretarsal orbicularis oculi muscle. Based on your photo, I don't think your muscle is prominent and so I don't think you would benefit from the injection in this location.

Michael H. Gold, MD · Answer

Thanks for your question and we always recommend that you have these injections performed by skilled injectors in the offices of board certified dermatologists or plastic surgeon. Yes, you are a candidate for having a very small amount of Botox in the lower lids to open your eyes more – again when given by a skilled injector.

Gregory H. Scimeca, MD · Answer

Thank you for your question. I have used botox for spastic entropion with over-action of the lower eyelid muscles in patients who have failed previous lid surgery and are not surgical candidates. However, botox will not effect the lower lid enough to change the position of the lid, especially in an otherwise healthy patient.

Alex Eshaghian, MD, PhD · Answer

Thank you for your question and for sharing your photograph skcrossley. 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 without a formal exam in the office where I can view the skin in multiple angles and observe wrinkles formed with facial expression. However, I hope the information provided here is useful.A small amount (1-2 units) of Botox may be placed just below the center of the eye. This relaxes the muscle that closes the eye and leads to a slight opening of the eye, in particular when smiling. Prior to such a treatment it is important to perform a snap test to ensure that there is no loose skin in the area. If there is loose skin, then the treatment is contraindicated as it can lead to dryness of the eyes.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 as described above. 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!

Andre Levesque, MD · Answer

Thank you for your question.Botox in the lower lid can certainly help some patients that have hypertrophied orbicularis muscle and develop a significant buldging of the muscle on smiling.I wouldn’t expect this to “open the eyes” as you desire.  Lowering the position of the lower lid is rarely indicated.  It is counterproductive for opening the eyes as the ultimate effect is an aged look and possibly a little “crazy eye” look.  We do not want to see the white part of the eye (sclera) above or below the colored part (iris).I would see several board certified physicians and let them examine you in person before committing to any plan.  Best Dr. L

Mark L. Mazow, MD, FACS · Answer

In general, Botox should be avoided in the lower lids for cosmetic purposes. There is a much higher risk of causing an ectropion(turning away) of the lower lid which can lead to exposure and dryness of the eye. It can be used in the lower lid in cases of Blepharopspasm by a specialized experienced injector, but I would discourage you from using this for the purpose you describe. Consult with a fellowship trained Oculoplastic surgeon for an in-person exam for options for you.

Leonard Grossman, MD · Answer

You have beautiful eyes that are proportionate to the rest of your face. Absolutely do not consider injecting Botox into the lower eyelid. 99.9% of individuals should never have Botox in the lower eyelids as it may cause major problems that are difficult to correct. Good luck from New York City

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