Puffy swelling under my eye after botox. My face looks even worse! Is this normal? (photos)

Question

I originally went in wanting a filler for under eye. The nurse talked me out of it saying I didn't need it and if anything to get just a few units around and under my eye. I agreed and we did 5 on each side. 3 days later I am left with a swollen face. My birthday is in a week and a half and I am panicking. I called the nurse and she said it shouldn't have swelled and doesn't know what it would be. I am going next Monday for a follow up. I did not exercise after botox that day but I did day after

Kenneth D. Steinsapir, MD · Answer

It really does matter who you go to. Just because someone is in a white coat and holding a syringe it does not mean they know what they are doing. What happened here is that the person injecting you with botox has no idea of how the lower eyelid muscle work. I seldom use botox in this location. Generally as you asked, filler is much better and the best of the fillers for this location is Restylane. The muscle in this area holds the top of the cheek together. When it is weakened with botox, it will sag and the result is what you see. I strongly recommend not chasing this. I would not immediately put filler into the cheek. The botox lasts 4 to 6 months but smaller doses of botox wear off faster than large doses. I would wait about 6 weeks, which will be after the peak of the effect of the botox and then consider your options which will most likely include the use of filler. I would not go back to this nurse except to ask for your money back. Exercising has absolutely nothing to do with what happened. Don't let them gaslight you. This is not your fault.

Monica Boen, MD · Answer

Thanks for your question and I am sorry you did not achieve the results you were hoping from your Botox injections. While some Botox experts can get great results injecting Botox underneath the eyes, it requires significant experience in the procedure to achieve an optimal outcome. Relaxing the muscle of the lower eyelid can impact the lymphatic drainage of this area and can be responsible for the swelling you are experiencing. Dermal fillers tend to be a more common choice in this area. Once your Botox wears off, I would schedule an appointment with a board-certified cosmetic dermatologist for a full assessment and personalized treatment plan. In the meantime, I would massage the area 4-5 times a day for 2 minutes for the next 2 weeks.

Alex Eshaghian, MD, PhD · Answer

Thank you for your question and for sharing your photographs Acorder443. 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 without a formal exam in the office where I can view the skin in multiple angles and observe wrinkles formed with facial expression. 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. 
Botox and fillers are two dermal (skin-related) products are both very popular for their anti-aging features. Unlike Botox, which relaxes muscles to smoothen out wrinkles associated with facial expression, fillers restore lost volume in various areas of the face and body. Common fillers include the Juvederm family (Juvederm Ultra, Juvederm Ultra Plus, Voluma, Vollure, and Volbella), the Restylane family (Restylane, Restylane Lyft, Restylane Silk, Restylane Refyne, and Restylane Defyne), Belotero, Radiesse, Sculptra, and Bellafill. With age changes occur in the bony structures as well as fat pads, both of which contribute to a youthful appearance. Over time bones move and change shape while fat pads get smaller by losing volume and move downward. Fillers restore such lost volume. Common areas of volume loss include the temples on the sides of the face, the upper cheeks, the tear trough area under the eyes, the nasolabial folds which go from the sides of the nose to the corners of the mouth, the marionette lines which are the continuation of the nasolabial folds to the jawline, the chin, and the jawline. Often times combining fillers with Botox treatments yields superior results.
Some people have a deficit under the eyes due to loss of or downward movement of the fat pad in the tear trough area. In some cases, the muscle around the eyes serves to hold up the upper cheek fat pad. If this muscle is relaxed with Botox (as it is when addressing crow's feet), this volume deficit can be exaggerated. In these cases, restoring the lost volume with fillers such as Volbella or Vollure under the eyes or Voluma in the cheeks can correct the deficit.
If I had a patient with the concern described here I would recommend following up with her injector and possibly adding some fillers as described above to correct the deficit.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.
  
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!

Puffy swelling under my eye after botox. My face looks even worse! Is this normal? (photos)

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Puffy swelling under my eye after botox. My face looks even worse! Is this normal? (photos)

Answers (3)

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Everything you need to know about Botox

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