Under eye area i.e 'jelly roll' not returning to normal after Botox - does it just need more time?

Question

Had botox treatment to crowsfeet and under eye (INNER CORNER) 4 months ago. Left eye was a disaster - puffs out i.e 'jelly roll' became pronounced when I smiled, creating more wrinkles underneath. Improved didn't ever return to normal. Went back to doc for next treatment, explained issue he assured me all okay and he did treatment to crowsfeet (not under eye). Only 24 hours later but the 'jelly roll' under my left eye is definitely puffing out, more rounded than I ever remember. Any advice?

Camille Cash, MD · Answer

Botox gradually wears off in 3-4 months for most patients.  If you are still having concerns I recommend returning to your injector for an evaluation.  It may be that a different treatment is necessary to improve the area that concerns you.

Monika Soni, MD · Answer

As someone who has injected people with Botox for more than 25 years, I can tell more from pictures than from your description. It is really tough to give you a credible answer without photos.

Alex Eshaghian, MD, PhD · Answer

Thank you for your question AnnieW77. 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.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!

Deborah Kessler Hudak, MD, MHA · Answer

As someone who has injected people with Botox for more than 25 years, I can tell more from pictures than from your description. It is really tough to give you a credible answer without photos.  Any chance you can send photos of you with "non-smiling" and "smiling" facial poses?

Under eye area i.e 'jelly roll' not returning to normal after Botox - does it just need more time?

Answers (4)

Answer: Jelly roll under eye after Botox injection

Answer: Jelly roll under eye after Botox injection

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Under eye area i.e 'jelly roll' not returning to normal after Botox - does it just need more time?

Answers (4)

Answer: Jelly roll under eye after Botox injection

Answer: Jelly roll under eye after Botox injection

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Everything you need to know about Botox

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