Puffy eyelids after botox - why does this happen and is there a solution? (photos)

Question

I have had Botox previously and no matter how small the does, it has made my eyes puffy above the eyelid, she also tried administering it in different ways as well as trying different brands, why is this? Is there a solution?

Juan Guillermo Breton, MD · Answer

First you have to consider how many units where used to control your crow's feet, the higher the dose, the higher risk of puffines, because we rely on muscle movement of our orbiculares oculli to help with water reting, beacuse the pump or lymph nodes. So next time less unite, you'll have maby less paralizing effect on your lines, but less risk of puffines. And another puffiness lasts like 4 weeks, it's not going to be permanent or through out all the duration of the effect

Randal Haworth, MD, FACS · Answer

It's possible that the puffiness you are experiencing above your eyelid after Botox injections is due to the « migration » of the product into the surrounding muscles or tissues. Botox is designed to temporarily paralyze the muscle that it is injected into, but in some cases, it can also affect nearby muscles, leading to unintended side effects such as puffiness or drooping.

It's also possible that the puffiness is related to the injection technique used or the specific product that was used. Different products and injection techniques can affect how the Botox spreads and interacts with the surrounding tissue.

If you have tried different brands and injection techniques without success, you may want to consider seeking a second opinion from a different injector or consulting with a board-certified dermatologist or plastic surgeon who has experience with Botox injections. They can evaluate your individual anatomy and recommend alternative injection sites or techniques that may be better suited to your needs. It's also possible that an alternative treatment, such as a dermal filler, may be more appropriate for achieving the results you desire.

Best of luck !

Anna Petropoulos, MD, FRCS · Answer

Hello and thank you for your question! First and foremost, we suggest a detailed, in-person evaluation by an experienced aesthetic provider to assess what may be causing this puffiness for you. 
In rare cases, toxin injections can affect lymphatic function around the eye. The lymphatic system in this area, responsible for draining fluids and toxins, depends on muscle movement and contractions. Since Botox works by paralyzing muscles, it’s often used to treat crow’s feet, which are located near the lymph vessels at the outer corners of the eyes. Gentle massage may be helpful. Start by massaging from the sides of the nose, moving outward across the cheekbones toward the ears. Doing this for a few minutes each day can assist in draining excess fluids and help firm the skin. Other treatments like radiofrequency (RF), laser, ultrasound, and topical products containing retinol and vitamin C are also recommended to enhance skin tightness around the eyes. Monitoring fluid and salt intake can also help determine if there is an overall water retention issue going on. Best of luck, Genie Alexander, RN BSN for Anna Petropoulos, MD FRCS at Center for Classic Beauty, Danvers & Boston, MA

Giuseppe Fiore, MD · Answer

Hi,
Thanks for your question and photos.

Rarely, toxin injections can impact lymphatic function around the eye. Lymph vessels and nodes in the ocular area are responsible for draining fluids and toxins, relying on movement and muscle contractions for this process. Botox, which induces muscle paralysis, is commonly administered for crow's feet treatment, targeting the outer corners of the eyes near these lymphatic vessels.

To assist lymphatic flow and reduce fluid stagnation resulting in puffiness, gentle massage can be beneficial. Perform a gentle massage starting from the sides of the nose, moving across the cheekbones and out towards the ears. Engaging in this massage for a few minutes each day may aid in draining stagnant fluids and promoting firmer skin.

In my clinical practice, I also suggest considering additional modalities such as RF (radiofrequency), ultrasound, microneedling, and skincare products containing retinol and vitamin C to improve skin tightness around the eyes.
I would suggest to make an appointment with an doctor expert in aesthetic medicine to to discuss your concerns and possible therapeutic plan. 
Regards, 
Dr Giuseppe Fiore

Jason Emer, MD · Answer

For unique cases where a variety of modalities could be used to treat the condition, I would suggest an in person or virtual consultation to develop a custom and effective treatment plan.  It is difficult to precisely define the best option without collecting the same information. I suggest reaching out to an expert for a consultation with surgical and non-surgical methods to get a comprehensive option. Best, Dr. Emer.

Alexander Golberg, MD, DO · Answer

Botox is a neurotoxin that works by blocking the nerve signals that cause muscle contractions, leading to a temporary relaxation of the muscles. While Botox is generally safe and effective, it can have side effects, including puffiness or swelling around the injection site.
In some cases, the puffiness above the eyelid that you have experienced may be due to the placement of the injections or the amount of Botox used. If the injections were placed too close to the eyelid, it could cause swelling. Alternatively, if too much Botox was used, it could cause the muscles to weaken excessively, leading to sagging skin and puffiness.
It's possible that your body may also have a sensitivity to Botox, which could contribute to the puffiness. In some cases, individuals may develop an immune response to the neurotoxin, which can cause swelling and other adverse reactions.
 To avoid this , the injection technique may be changed or the amount of Botox used to minimize your side effects. Or in case your body developed immune response to the neurotoxin , different treatments might be suggested

Douglas Taranow, DO, FACOS · Answer

Botox is a neuromodulator that 'paralyzes' muscles intimately surrounding each injection site.  It rarely causes swelling (although everyone is different).  More commonly, Botox placed above the eyebrows relaxes the forehead muscles which allow the forehead and brow to 'drop' slightly downward which may cause a heaviness appearance of the upper eyelid.  
If what you are experiencing is truly a swelling effect from the Botox, then taking Benadryl at night, and Claritin (non-drowsy) during the daytime.  Alternately, your injecting plastic surgeon may give you several tablets of Prednisone (an oral steroid) which usually reduces swelling rapidly.
Best wishes,
Dr. Taranow

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