Does Botox wear off unevenly? (photos)

My eyes are distinctly 2 different sizes. Is it possible my Botox has worn off unevenly? Or is it just a coincidence and something else is wrong? My eye more closed feels heavy.

Doctor Answers 13

Botox uneven

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It is possible fore Botox to wear off unevenly. I recommend you to see your injecting physician to go over before and after pictures to see if there was any asymmetry prior to getting Botox. We are not symmetric, procedures may enhance any underlying asymmetries that went unnoticed before. Botox typically lasts for 3-6 months, so in time you will know if the asymmetry was preexisting. 

Fayetteville Facial Plastic Surgeon
4.7 out of 5 stars 127 reviews

Botox wearing off unevenly

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Thank you for your question mlburnett. Most people enjoy the results from their Botox treatments for three to four months. And sometimes it wears off faster in one area of the face than another. Be sure to take photographs both before and after a treatment. Sometimes a patient notices a change after a treatment but when we look at her pictures before the treatment it looks the same. This is because when we notice something in the face sometimes we overlook or don't notice another thing. When the first issue is corrected, then another one becomes more noticeable. It is also important to remember that the two sides of the face are not perfect mirror images, so some asymmetry is normal and actually desirable. I recommending following up with your doctor to review your photographs and for specific recommendations. Good luck!

Many Reasons for Facial Asymmetry

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Great question! It's certainly possible for BOTOX to wear off at varying rates across the face. There are other possible explanations for what you're experiencing, too. As other doctors have suggested, it's possible that you're noticing an existing asymmetry now that you're paying more attention to this area of your face. BOTOX can also exacerbate asymmetries like this. It really depends on where you had the BOTOX. In any case, this change is unlikely to be permanent. If you see these changes enduring past the 3-month mark, see your injector.

Suzanne Bruce, MD
Houston Dermatologic Surgeon
3.7 out of 5 stars 6 reviews

Botox Wear Off Unevenly?

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It is possible fore Botox to wear off unevenly. Evaluation of your "before" Botox photos taken with the same lighting, same facial expression, and same position as your "after" Botox photos will give you a better of idea of whether or not you had preexisting asymmetry. We are not perfectly symmetric. Sometimes procedures make us more aware of our underlying asymmetries that were present before but we just didn't notice because we weren't scrutinizing our appearance as closely. Good news is that by 6 months, you'll have your answer as the Botox should have worn off by that time!

Does Botox wear off unevenly?

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Hello, and thank you for reaching out to us.
It may wear off even or uneven. It may accentuate the asymmetry that naturally exists in all of us. Working with your board certified surgeon or expert injector to discuss adjustments to your treatment plan is recommended to help perfect your treatment and recovery plan.

Good luck, please let us know how it goes.

-Dr. Constantino Mendieta

Uneven botox effect

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the concentration of botox and number of units injected will determine the effectiveness of botox
2 it is also dependent on where it is injected
3 technical ability of the injector also has some value 
4 duration of effect is dependent on concentration and number of units injected

Kimit Rai, MD, FRCS(C)
Surrey Plastic Surgeon

Eyes appear different sizes as Botox is wearing off

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It is hard to say if this is Botox related or just an underlying asymmetry that is being noticed. Botox can wear off asymmetrically but that is usually related to injections which were initially asymmetric. We have have a big side and a little side, or a good side and a bad side. This is just probably related to that.

Steven F. Weiner, MD
Panama City Facial Plastic Surgeon
4.9 out of 5 stars 75 reviews

Don't know - not enough information

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You didn't mention where you had the botox - around the eyes, forehead nor when.  Botox typically lasts for about 3 months.   Without this information, I cannot speculate what the cause might be.  You do have a minimal amount of asymmetry with the left eyelid being slightly lower than the right.  Good luck.

Elliot Duboys, MD, FACS
Long Island Plastic Surgeon


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Botox and other neuromodulators such as Xeomin or Dysport can indeed wear off slightly unevenly although that is not a common phenomenon but definitely possible. If that is something that bothers you, though, a minor touch-up with a neuromodulator may be done on the affected side or you may get re-treated on both sides. Best wishes!

Thomas J. Walker, MD
Atlanta Facial Plastic Surgeon
5.0 out of 5 stars 29 reviews

Botox worn off unevenly

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It is possible for botox to be worn off unevenly.  You may just need a little touch up.  Follow up with a board certified dermatologist or plastic surgeon for a touch up.
Dr. Buatti

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.