Is it possible to treat an overactive eye muscle with Botox? Or any other way to balance eye shape in this case? (Photo)

Question

The muscles around my right eye tend to tighten much harder than my left, resulting in a bag look under my eye & surrounding. Also making the right eye appear smaller. I try to relax it but its just a stubborn/tense eye muscle lol. I'm wondering if Botox could be used, reducing the muscle size and bring my eyes into more symmetry?? I've never tried any injections, and wondering if its possible for this specific muscle without losing the ability to close my eye normally. Thank you for any advice!

Rupert Critchley, MD, MRCGP · Answer

Hi there!Small amounts of botox targeting muscles around the eye may alleviate the muscle tightness. The procedure is quick and painless, lasting 3-4 months. Please make sure you consult an experienced practitioner. Best wishes,Dr Rupert

Michael A. Zadeh, MD, FACS · Answer

These are the situations in which a single shot photo does not tell the whole story. You need an in-person consultation and examination, especially whilst observing the muscle movement in action. In general, expertly placed Botox may be able to help improve symmetry by weakening muscle action. When done right you should have no issues in closing your eye. Make sure you see an experienced physician injector. Best wishes.

Jason Emer, MD · Answer

Botox can be injected into these areas to create a softer look. The botox will essentially relax the muscles creating the appearance of atrophic muscles. The results will last up to 3-4 months hence you will have to re-inject roughly 3x per year. When administered by an expert injector you shouldn't have an issue with too much laxity. I recommended getting a formal evaluation with a cosmetic dermatologist to figure out your best treatment options for your eyes.Best, Dr. Emer.

Kenneth D. Steinsapir, MD · Answer

You have a mild left upper eyelid ptosis.  There is also a left compensatory eyebrow elevation and a corresponding under action of the right eyebrow. Using botox it might be possible to address some of these issues.  You you need a highly customized approach and most botox injectors are not at all familiar with what is needed to perform this time of work. As only small doses are used, treatment tends to be relatively expensive (because you are asking for a tricky treatment by a highly experienced injector). Also due to the relatively small doses involved, treatment is only likely to last 6 to 8 weeks at a time rather than the 4 to 6 months that we commonly expect a botox service to last.  The long term fix is upper eyelid surgery to address the upper eyelid ptosis. I suspect you have an early anterior levator disinsertion due to the fact that you have left upper eyelid lash ptosis. That means that a commonly performed Muller's muscle conjunctival resection ptosis surgery will not be right for you in my opinion.  You need anterior levator ptosis surgery with an anchor blepharoplasty. This will restore the jewel like sparkle to your eyes that is missing. It all starts with a detailed personal assessment.

Monika Soni, MD · Answer

Thank you for you question! Botox can be injected into these areas to create a softer look. The botox will essentially relax the muscles creating the appearance of atrophic muscles. The results will last up to 3-4 months hence you will have to re-inject roughly 3x per year. When administered by an expert injector you shouldn't have an issue with too much laxity. I recommended getting a formal evaluation with a cosmetic dermatologist to figure out your best treatment options for your eyes. Best of luck!

Johnson C. Lee, MD · Answer

A very small amount of targeted Botox therapy can help reduce the intensity and size of your hyperactive side. The injection takes seconds and will start working in about a week. You should expect a touch-up injection every 3-4 months until the sides match. Hope this helps!
Johnson C. Lee, MD 
Board-Certified Plastic Surgeon
IG: @drjohnsonlee

Shaun Patel, MD · Answer

Neuromodulators like Botox and Dysport can certainly be used to relax the orbicularis oculi muscle. In you case, I recommend that you schedule an in person consultation to determine if you are a good candidate for treatment and if it would help you achieve the correction you are looking for.

John Tanqueray, MBBCh · Answer

Thanks for your question - firstly yes there is no reason that the right side cannot be treated to ensure that any contribution that an overactive muscle is causing is reduced, and this won't affect your ability to close your eyes.Looking closely at your photos it appears that there is a little hooding from the upper eyelid, which is making the right eye appear smaller, but on the right hand photo the eyes themselves appear the same size. It is usually possible to create some lift with toxin, but you would of course need a face-to-face consultation to analyse what is going on and what the possible options are.Best of luck.

Alexander Blandford, MD · Answer

Thank you for your question!
To evaluate for an overactive muscle around the eye (orbicularis oculi) an in person evaluation is necessary to assess for changes with dynamic facial expression.
In your photo, you mentioned "right lower eyelid bag". At times there can be hypertrophy (thickening) of the orbicularis muscle in the lower eyelid that can cause fullness in the area, particularly with facial expression. Orbicularis muscle hypertrophy can be softened with botox. It is difficult to say based on your picture if this is present in your case. Other sources of "lower eyelid bags" can be swelling if it fluctuates throughout the day,or subtle prolapse of orbital fat into the area. Treatments for this type of lower eyelid fullness would not include botox and can vary from treating the underlying cause of swelling to conservative removal or repositioning of the fat.

Also, from your photo you can see that your upper eyelid platform is slightly smaller on the right compared to the left. This is related to your right brow being slightly lower and causing the skin to drape differently on the eyelid. It is normal to have subtle asymmetries and this can be from bony differences as well as muscle differences (frontalis). Asymmetries are often seen in what the public views as beautiful people. However, if this asymmetry bothers you then carefully placed botox can play a role in gently lifting the right brow.

Hope this helps and all the best!
Alexander Blandford MD
Oculofacial Plastic and Reconstructive Surgery
Vero Beach, FL

Razieh Soltani, MD · Answer

I would start with 1 unit of Botox injected superficially in the lower eyelid just below the mid pupillary line. It will not affect the ability to close your eyes. Adding some filler (Belatero or Restylane Silk) can also help soften the baggy appearance of lower eyelid. I recommend finding a trained MD for this procedure.

Is it possible to treat an overactive eye muscle with Botox? Or any other way to balance eye shape in this case? (Photo)

Answers (12)

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