Can Botox wear off unevenly? How can this be treated? (Photos)

Hello! My name is Jessica, I am a physician assistant, and one of the providers at Aesthetic Skin in Winnetka and Chicago. This is a great question. Yes, Botox can wear off unevenly, especially around the eyes where the muscles are small and very active. Each side of the face naturally uses slightly different muscle patterns, so as the Botox starts to fade (usually around 8–12 weeks), one side may regain movement faster than the other. This can temporarily make one eye look more open, smaller, heavier, or “different” than the other. It doesn’t mean anything is wrong with your eye itself—just that the treated muscles are returning to their normal strength at different speeds. Since your exam was normal, this is almost always a cosmetic, not medical, issue and typically evens out as the remaining Botox fully wears off.

Thank you for explaining what happened — I know how unsettling it can feel when your eyes suddenly look different, especially weeks after treatment. Based on your timeline and symptoms, here’s what may be going on:

Botox can absolutely wear off unevenly, especially after a first-time treatment. Even though you received the same general dose on both sides, each eye has its own muscle strength, habits, and anatomy. That means one side may regain movement faster than the other.

When this happens around the crow’s feet or jelly roll area, the muscles can start functioning asymmetrically, which can make one eye appear larger, smaller, more open, or more relaxed than the other. This is common and not dangerous — especially since your eye exam showed everything structurally normal.

A few key points to consider:

Uneven wear-off is normal.
Botox typically fades gradually, but it doesn’t always fade at the exact same rate on both sides. This can create temporary asymmetry, especially around delicate muscles like those under the eye.

The timing matches typical Botox fade.
Around 8–10 weeks after treatment, Botox is often in its “transition phase.” This is when unevenness is most noticeable as the muscles start waking up at different speeds.

Why your eye looked suddenly different:
Even though the change felt sudden to you, small shifts can add up and only become noticeable when one side releases more movement than the other.

How this can be treated:
When Botox fades unevenly, the usual approach is a small balancing touch-up once the muscles settle. A very conservative dose can help even out the asymmetry, but this is done only after the effects have stabilized.

What to expect now:
The good news is that this type of asymmetry is temporary, and as both sides continue to wear off fully, the eyes typically return to their baseline appearance.

It’s completely understandable to feel stressed when your facial balance changes, but what you’re describing fits a very common pattern of Botox behavior — especially involving 20 units across multiple small muscle groups. If you’d like, I can also explain what signs to watch for as the Botox continues to fade and what a gentle correction typically looks like.