Crows feet Botox - still swelling after 5 months. What can I do?

Question

I had Botox for the first time in my crows feet 5 months ago, swelling under my eyes/top of cheek bones occurred 2 weeks later and has still not gone! I’ve never been so depressed about my appearance in my life, I look about 20 years older and no one can help me, I’ve tried absolutely everything and nothing is helping

Anna Chacon, MD, FAAD · Answer

I can understand how upsetting this must be, particularly when you expected a temporary cosmetic treatment and instead have been dealing with persistent swelling for months. Swelling around the lower eyelid and upper cheek can occur after Botox around the crow’s-feet area, although it is relatively uncommon. Eyelid edema has been reported in clinical studies and is a recognized periocular complication.

What concerns me most in your situation is the five-month duration. Typical Botox-related periorbital edema is generally temporary and often resolves within weeks, while the muscle-relaxing effect of Botox itself gradually diminishes over approximately 3–6 months. Persistent swelling at five months therefore deserves a careful evaluation rather than simply waiting for more Botox to wear off.

One possible explanation is that weakening the orbicularis oculi muscle altered the normal pumping action that helps move fluid away from the lower eyelid and cheek. This can contribute to fluid accumulation in susceptible individuals. Other possibilities include an unrelated eyelid or skin condition, allergy/inflammation, thyroid or systemic causes of edema, or another issue that happened to become apparent after the injection.

I would not recommend additional Botox to the area while the swelling remains unexplained. I would also avoid trying multiple cosmetic treatments simply to counteract the appearance until the cause is established. The treatment needs to be directed at the reason for the swelling, rather than just the swelling itself.

If the swelling is soft and fluctuates throughout the day, particularly if it is worse in the morning, that can provide useful information about fluid retention. A physician may also examine your eyelid position, tear function, surrounding muscles, and the tissues of the lower eyelid and cheek to determine whether the Botox contributed to the problem or whether another condition is responsible.

If you develop eye pain, significant redness, vision changes, double vision, severe headache, or rapidly increasing swelling, that warrants prompt medical evaluation. Periocular Botox can rarely affect ocular function, and persistent or significant symptoms should not simply be attributed to the cosmetic injection.

Most importantly, I would not assume that your appearance is permanently changed. Botox itself is temporary, and many of its periocular effects resolve as neuromuscular function returns. The fact that you've had swelling for five months means the next step should be identifying why it has persisted rather than continuing to treat it cosmetically.

Camille Cash, MD · Answer

After 5 months the Botox has likely worn off.  From your description you may have festoons.  I encourage you to visit with your injector or a board certified plastic surgeon to evaluate your swelling concerns.

Bao Ngoc N. Tran, MD · Answer

By injecting Botox to the crow feet area, the muscle around the eyes are weakened and laxed which can cause festoons or malar bags. This often happens to people who have “hidden” festoons and Botox reveals or makes it worse.

Crows feet Botox - still swelling after 5 months. What can I do?

Answers (3)

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