Is it a common side effect to have huge cheeks after botox? (Photo)

Thank you for your question and photographs.  Botox does not normally cause any effects to your cheeks when injected for crows feet.  The amount of fluid injected with Botox is very small, and is quickly absorbed by the body.  What may have occurred with the bruising you described is that you developed a small hematoma underneath the skin that caused swelling in that area. This is also most likely the cause if only your left cheek has been affected.  If this is indeed the case, your cheek should decrease in size within a week or two.

Botox can cause some minimal swelling after injection. Usually it resolves itself within 72 hours after the injection. Follow up with your provider if you're concerned that it was caused by the Botox.Thank you for your question and for sharing your picture!Kate Ross, MD

It is always nice to see pre-treatment photos.  As for the swelling, if the botox was just injected, this can be the cause. It also can be related to malar mounds which are like swollen legs and can get worse when muscle function is weakened in the area.  If so, and if due to Botox it might take several months to improve.

Dear "September Girl:"When you inject botulinum toxin A into the periorbital muscles, obviously, they will relax. But the muscles that lift your cheeks will not.  Since they are lifting but the periorbital muscles are not being pulled up as well, a shelf of muscle can form at the upper outer cheeks, pushing back onto your cheeks and giving your cheeks an apple-like shape. Perhaps this is what you are perceiving as puffiness. For this reason, I use very low doses of BTX-A, if any at all, to the smile lines.   Sometimes using filler will improve the smile lines with a more natural result than BTX-A.All the best, Dr. Clark