Puffy and Drooping Eyelids After Botox

I have severe puffy and drooping eyelids after Botox. What can be done? Botox eye droop. I also have severe puffiness in eyelids. I was injected in the forehead and between brows. I still have the one wrinkle I wanted gone between brows...ARGH.

Doctor Answers 10

Droopy eyelids

Eyelid droop can be corrected with a prescription eye drop (Iopidine 0.5%). This can help alleviate the droop within a few weeks to a month. You can also wait a couple of months for the effects of the Botox to wear off, at which point the droopiness will also go away.

Toronto Plastic Surgeon
5.0 out of 5 stars 179 reviews

Consult a Skilled Injector for Puffy, Droopy Eyelids

One of the things everyone needs to know is you need to go to a skilled injector – and you should be consulting with a board-certified dermatologist or plastic surgeon – and people in their offices.

If your toxin injection was within the past several days, you can expect that the puffiness, which is not easily seen in the picture you provided, will lessen and most likely go away pretty. Apply some ice to the area; that will help a lot.

If you have droop – which we call ptosis – this can occur with toxin injections, even with skilledinjectors. You can use special eye drops to make the condition better and they will be useful until the toxin goes away. You need to call your injector and get this taken care of as soon as you can.

Did you have any planned follow-ups with your injector? Most of us would recommend you see your injector at two weeks after the injection to make sure things are OK and you are where you and the injector want to be. In your case, you still have a small crease present, which may need a small amount of filler to correct.

Michael Gold, MD
Nashville Dermatologic Surgeon
4.0 out of 5 stars 18 reviews

This is due to the brows dropping after Botox

Your eyebrows have descended a bit after the treatment. This is a result of the BTX taking out the muscles that elevate the forehead. As a result, the skin of the upper eyes tends to become redundant and puffy looking. If you manually raise your brow, you will see an improvement to the pre-injection state.

One way to correct this is to have your doctor inject the muscles that are pulling the forehead down unopposed. While he is at it, give another bit to the wrinkled area.

The other option of course is to wait it out, which usually takes 3-7 months.

Hope this helps.

Scott E. Kasden, MD, FACS
Dallas Plastic Surgeon
4.8 out of 5 stars 106 reviews

Botox eye droop

Eyelid drooping after neuromodulators like Botox, Dysport or Xeomin is a rare but well described issue, usually resulting from product placement or the amount used. 

The first thing that needs to be determined is whether it is a droopy eyebrow or truly a droopy eyelid. Droopy eyebrows are much more common and result from immobilizing the only muscle on the forehead that is able to lift up our eyebrows. Droopy eyelids come from the product getting into the wrong muscle that elevates the eyelid. 

Management of them is quite different, but both have strategies to help expedite resolution while waiting for them to resolve with time, and any experience injector should be very familiar with how to deal with them: drops for the eyelids and precise placement of Botox in the brow depressors when it is an eyebrow issue. 

To ensure you are receiving the highest level of care, seek out a modernly trained, new-school dermatologic surgeon, oculoplastic surgeon, facial plastic surgeon or plastic surgeon who is board certified and fellowship trained in one of these "core four" cosmetic specialties. Membership in organizations like the American Academy of Facial Plastic and Reconstructive Surgery help to identify a highly trained surgeon.

Cameron Chesnut
#realself500 Physician

Cameron Chesnut, MD, FAAD, FACMS
Spokane Dermatologic Surgeon
4.9 out of 5 stars 105 reviews

Puffy Eyelids After Botox

If it occurred immediately after the injections, then it is likely due to swelling or hematoma which will resolve over a few days to a few weeks, respectively. If it did not occur for 3 to 7 days after the injections, then you may have to wait several months .The full effect of the Botox typically lasts 3-4 months, and your hooding and puffiness may last that long. However upper eyelid drooping is temporary. The best news is that it will go away when Botox wears off, in several months.

Hardik Soni, MD
Summit Emergency Medicine Physician
5.0 out of 5 stars 45 reviews

Botox in brows - side effects

The puffy and drooping lids you are noting are seen when your injector places Botox in the frontalis muscles.  Some people may be more sensitive to being injected in this area and experience flattening of the wrinkles in the forehead  but an inability to lift the forehead causing this perceived droop.  Wait for this to wear off and then tell your next injector that you did not like your forehead injected too low.

Sean Paul, MD
Austin Oculoplastic Surgeon
5.0 out of 5 stars 18 reviews

Droopy eyes after Botox

Thank you for your question. Sorry to hear about the droopy eyes. It sounds like you are experiencing ptosis of the eyelids and brows.  They eyelid portion can be partially corrected with the use of eye drops. Your physician would need to prescribe it. It will also wear off as the effect of Botox wears off.

Young R. Cho, MD, PhD
Houston Plastic Surgeon
4.8 out of 5 stars 38 reviews

Puffy Eyelids After Botox

Hello.  It's difficult to see from the photo how much eyelids because we don't have the "before" picture.  The good news is that because Botox is only temporary, the effects usually only last about 6-8 weeks.  

The condition is called ptosis and it occurs when the Botox is injected incorrectly in the forehead.  The product migrates to muscles that are not targeted.  The Botox relaxes these muscles and causes the eyelids to appear heavy or puffy.  Iopodine drops may help speed the resolution of the problem.  Ask your injector about them.

As for the crease that remains in between the eyes, it looks like you may need some dermal filler.  Your injector should have set the expectation that a deep furrow line like this might need Botox AND dermal fillers.  Good luck.

Harold J. Kaplan, MD
Los Angeles Facial Plastic Surgeon
4.4 out of 5 stars 7 reviews

Botox in brows

Botox injected into the brows can cause sagging and a heavy lid look in some individuals especially those with heavy brows.  See your doctor.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 29 reviews

Botox in the forehead can cause eyebrows to sag

The forehead muscles are responsible for raising the eyebrows, so if you inject Botox there, you run the risk of not being able to raise your eyebrows. (I always caution my patients of this side effect, and undercorrect the forehead). Unknowingly, you must have been using your forehead muscles (frontalis) to raise your brows and keep the eyelid skin up. Once the eyelids droop, it can look like puffiness because the excess eyelid skin is bunching up.

Now that your brows are drooping, you can try doing exercises to raise your eyebrows and strengthen those muscles. This can help the Botox wear off quicker. Sometimes taking Calcium supplements can also help to speed up the Botox metabolism. Other than that, there's nothing else to do but wait.

The good news, though, is that now that the Botox is working you just need a little drop of Restylane or Juvederm to fill in that pesky line that's bugging you and you will have a smooth line free forehead.

In the long term, you may wish to consider upper eyelid surgery with eyebrow fixation for a more permanent and aesthetically pleasing result..

Jonathan Hoenig, MD
Beverly Hills Oculoplastic Surgeon
5.0 out of 5 stars 40 reviews

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.