More Botox for Sagging Eyelids from Prior Treatment?

I had Botox done on my forehead, between my eyes, and on my crow's feet (side of eyes). I noticed that the injections for crows feet flattened the side of my eyes, pushing my eyelid skin to the center of my eyes, making them appear heavy with skin. I was thinking of getting more Botox to open my eyes back up. Any advice?

Doctor Answers 10

Don't Do It

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What you're describing sounds like Botox may not be the best for you. Patients that have excess skin of the upper lids and descent of the brows will run into problems when injected with Botox. Botox can worsen these problems and certainly will not improve your situation now.

My suspicion is that you may be in need of a brow lift and/or upper lid blepharoplasty. See your board certified plastic surgeon to be evaluated.

Botox does not tighten skin

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It sounds as if you may be using Botox to treat problems that may be better suited to surgical correction. If that is the problem, this may be as good as it gets.

If you have excess skin, there is lttle that can be done to truly shrink it other than to remove it by surgery.

Allow the Botox to wear off and obtain consults from 2 or 3 surgeons and proceed based on what seems to be the most sound advice.

IF you continue to use Botox as an alternative to surgery, be aware that it will relax skin and wrinkles but do little for skin redundancy or excess.

Otto Joseph Placik, MD
Chicago Plastic Surgeon
4.9 out of 5 stars 86 reviews

90% of the questions I answer deal with Botox complications and misplaced breast implants.

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To Poetrygirl,

Hi. Maybe there is a lesson here. A popular question is How much does Botox cost, without realizing that this is an invasive procedure, that can be legally performed by anyone with an MD degree (and in some states, by anyone with a RN degree). Many of these people are not properly trained.

Of course, I don't know who treated you, or exactly what happened. But here is my advice. Do nothing for 4 months. Then go to a board certified plastic surgeon, and ask her or him what is best for you. And ask to see a lot of before and after pictures.

The advantage of a plastic surgeon over a dermatologist (and there are a lot of great dermatologists) is that the plastic surgeon can offer you the full spectrum of treatments.

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon

Botox is not your answer... maybe surgery for your sagging eyelids

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It sounds as though you have laxity of eyelid skin that needs to be addressed with a blepharoplasty. Patients who have wrinkles on the sides of the eyes (crows feet) typically have a very good response to Botox.

However, if you already have sagging excess skin under your eyelids, then this can be a problem for some patients. The reason is because when you look at yourself in the mirror, you are not drawn toward the smooth areas on the sides of the eye, but rather will focus on the sagging skin only. This makes it seem more noticeable.

The best advice is to discuss with your surgeon how much excess skin you have and whether you are a candidate for eyelid surgery. Botox will not help the area you are describing. Good luck.

Sirish Maddali, MD
Portland Plastic Surgeon

Sagging lids from Botox

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I agree with the other responders. Additional botox is unlikely to give you a satisfactory result at this time. It is likely that within 3 months, you will notice improvement in the sagging appearance (hopefully sooner).

Of course we cannot tell with certainty what you may benefit from based on your posting, but perhaps you would benefit from a brow lift +/- upper lid blepharoplasty. I would notify your treating physician of your concern to decrease the likelihood of this happening to someone else or to you again.

Good luck.

Bryan K. Chen, MD
San Diego Dermatologist

Botox Causing Sagging of Upper Eyelid Skin

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Hi Poetry Girl,

The elevating muscles of your forehead have been weakened by the Botox treatment, making your brows heavy and creating the appearance of more skin on your upper lids.

Unfortunately there is not much to be done other than to wait for those muscles to recover. In some patients it may be a few weeks.

Please let your injecting physician know so that it can be noted on your chart, and hopefully avoided in the future.

I hope that your eye lids improve quickly. Be well.

Dr. P

Michael A. Persky, MD
Encino Facial Plastic Surgeon
4.8 out of 5 stars 39 reviews

Botox for Heavy Eyelids?

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You've gotten some great feedback from the panel, albeit somewhat varied.  There could be a number of things going on.

You may need surgery if you have too much excess skin as some panel members have mentioned.

You may have some sagginess or heaviness in the lids caused by the previous Botox injections and this situation will work itself out over the next few months if that is what is happening.

It may also be that you would benefit from a Botox browlift as Dr. Berkowitz has suggested.  See the link below for our description of this procedure and the before and after pictures for it.

It's difficult to say without seeing your situation up close what we would suggest.  Good luck.

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

Botox has its limitations...

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I am a huge Botox fan, but the one area in which it will disappoint is in patients with lax skin on the eyelids. Botox relaxes muscle movement, and if the skin is loose and doesn't move as much, it might lose even more of its spring. More Botox is likely not the answer. Fractional CO2 laser likely would help as would surgical eye lift.

Mary P. Lupo, MD
New Orleans Dermatologist
5.0 out of 5 stars 18 reviews

Please dont do this.

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Dear Poetrygirl

Clearly you are having an issue with your recent BOTOX treatment. Somethings can be fixed or adjusted with a tiny bit more of BOTOX but not very many things and not the problem you are having.

I don't doubt that you might be able to talk your doctor into this but I can't recommend it. You are going to need to wait for the BOTOX treatment to wear off for this problem to resolve. This could take a few weeks or a few months depending on exactly how much BOTOX was used.

Once it has worn off, I would recommend that you find a new doctor to do your BOTOX treatment, or at least don't let your current doctor treat this same area again.

Again there is no instant fix for this problem, time will correct it. Don't compound the problem by getting more BOTOX right now no matter how depressed you might be looking at this issue.

Kenneth D. Steinsapir, MD
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

Botox Brow Lift can open up tired-looking eyes

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Not all injectors have the experience to create a brow lift using Botox. That said, not everyone can achieve a lift from Botox. There are muscles that surround the eyes that pull the brow down and their are muscles that lift the brow. The art is placing sufficient Botox into the muscles pulling the brow down that these muscles become relaxed so that the lifting muscles will raise the brow and lift the eyelids. If too much Botox is given in the muscles that lift the brow the pendulum swings the other way and the brow falls. Find an experienced cosmetic surgeon to perform this delicate balance. I have been performing Botox injections for over 15 years.

Mark Berkowitz, MD
Sterling Heights Oculoplastic Surgeon
4.8 out of 5 stars 65 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.