How long does it take for puffy eyelids to resolve 6 days post Botox?

Question

Hello doctors! I had Botox in my forehead and outer eyes (first time) 6 days ago. Around the forth day I woke up with very swollen eyelids that made putting on my eyeliner a mess! Swelling is definitely worse in the mornings and by late evening is about 50% decreased. I have tried antihistamine and Advil for swelling, which didn’t help too much. How long before this swelling and eyelid bagginess resolves? What can I do, if anything at all?

Michael J. Weinberg, MD · Answer

Botox is very
safe when it’s used around the eyes. It’s very unusual for Botox alone to cause
puffiness. It may  however cause puffiness when used in combination with a
filler. This may go away in 3-4 months when the Botox wears off but may take
longer and thus depend on the filler dissolving.

Kenneth D. Steinsapir, MD · Answer

Most likely, your botox paralyzed your forehead lifter muscle. Injectors like injecting the forehead because they think that is where the lines are. Of course this kills the ability of the frontalis muscle to raise the eyebrows. That makes the eyelids heavy. You say swollen but (no picture here so you are making me guess) the brow tissue is left to cascade down into the eyelid space. So that would be your treatment. Study my patented Microdroplet Lift®. This only treatment the muscle that pull the brow down and leave the frontalis muscle untreated. That gives you a balanced forehead lift without the forehead freeze.

Alex Eshaghian, MD, PhD · Answer

Thank you for your question Pinkwillow. 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. The safety record of Botox is well established. The product has been used for over 20 years for a variety of treatments with minimal side effects. Botox is amongst the safest treatments for treating facial wrinkles.
  
While Botox is one of the safest treatments offered, there are some situations where it is not appropriate. These include anyone who has an allergy to any of the inactive ingredients or who has had an allergic reaction to any botulinum product including Botox, Dysport, Xeomin, or Myobloc. The safety and efficacy of Botox has not been established in women who are pregnant, trying to become pregnant, or breast feeding. Therefore, women in these categories are advised to wait until breast feeding is completed prior to having a Botox treatment. Botox should not be placed in the skin on the site of an infection. Those who are taking an aminoglycoside antibiotic, an anesthetic, D-penicillamine, antimalarials, or immunosuppressants should not be treated, nor should those who have undergone chemotherapy within the previous six months. It is important to avoid blood thinners before and after a treatment. These include both prescription and non-prescription medications such as warfarin (coumadin), aspirin, ibuprofen, alcohol, fish oil, vitamin E, and ginko biloba. Those with conditions that affect muscles and nerves such as amyotrophic lateral sclerosis (ALS or Lou Gehrig's disease), myasthenia gravis, or Lambert-Eaton syndrome should not undergo Botox treatments.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.
  Swelling is rare with Botox and more common with fillers. To reduce swelling I recommend that my patients apply cold compresses on and off for five minutes at a time, sleep on an extra pillow, and avoid salty foods for a few days. If I had a patient with the concern descried here I would likely say that the swelling is not due to the Botox since it started four days after the treatment. Swelling from an injectable treatment is usually seen immediately after the treatment or possibly the next day and resolves with the measures described above. I would recommend consulting with a general physician as the swelling may be seasonal allergies or due to something else.
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!

Kristine Brecht, MD (license suspended) · Answer

Dear Ontario,Thank you for your question.I have seen patients rarely have post Botox residual swelling, most do not.It is temporary and resolves without sequela after 5-10days.Sleeping with extra pillows under your head and light massage of the swollen are will help it resolve faster.Best. Dr Brecht Seattle, Wa

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