Swollen/puffy inner eyes 3 days after Botox. (photos)

Question

I had Botox 3 days ago. Within an hour of injecting, my inner corner of my eyes became swollen. I am also swollen/puffy across the bridge of my nose. Also have a 'bag' under one eye. I have contacted the nurse who administered and she says it's not caused by Botox.... I have had Botox injections many many times before and have never had this issue. Please help.

Kenneth D. Steinsapir, MD · Answer

Your nurse injector caused this by injecting too low in the lateral crowsfeet area.  The botox drifts into the orbicularis at the top of the cheek.  This weakens the muscle and causes this bag. Do not chase this with additional treatment.  Let this recover on its own.  Avoid low crowsfeet treatment in the future.  It may take one or two months to see this resolve.

Elham Jafari, MD · Answer

Hi and thank you for your question! Over years I have performed several thousand Botox injections and have never seen a similar situation. Some minor swelling right after Botox injection is common and it goes away within hours. In your case, the swelling and puffiness might be an incidental issue unrelated to Botox, but you do not want to tame any chances and in case it doesn't improve shortly you need to follow up with your provider to rule out complications. I hope it helps and good luck!

Roxana Kerns, MD · Answer

First on my list would be to immediately book a follow up appointment with the practitioner that treated you. Avoid sleeping face down or side ways, use 2-3 pillows to keep head up, avoid head down positions for too long and ice. Botox is temporary and so are results associated with the injection. Evan if you were to not do anything about it you should still see full resolution in 1-2 month time.

Martie Gidon, MD, FRCPC, FAAD · Answer

Incorrect placement of the Botox, too many units, or too deep injections can cause this problem.  You will need to wait until the Botox effect wears off.  Sleep with your head elevated and avoid salt and alcohol which will lead to more puffiness.  Cold brewed green tea bags in the morning can help reduce puffiness.

Alex Eshaghian, MD, PhD · Answer

Thank you for your question gabourkiel. I understand your concern. Botox
is a purified protein used to address wrinkles associated with facial
expression. It can be used to address the crow's feet seen around the eyes when one smiles. When used for this purpose, the orbicularis oculi muscle is relaxed. This is the muscle the goes circumferentially around the eyes. Some people have a loss of volume in the tear trough under the eye. In some of these cases this muscle is used to hold up the upper cheek fat pad. When relaxed with Botox, the muscle is incapable of performing this function. In these cases hollowing or bags can be seen. This goes away on its own as the Botox wears off after 3-4 months. Some have proposed that radiofrequency treatments may lead to wearing off faster. Fillers can also be placed in the tear trough to address the deficit. In these patients future treatments should avoid placement of Botox in the lower portion of the muscle. Swelling can occur after any injection. I recommend that my patients apply cold compresses such as ice packs to reduce swelling. Please consult with a doctor for specific recommendations. Good luck!

Swollen/puffy inner eyes 3 days after Botox. (photos)

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