I had Botox 8 weeks ago and my eyelid skin is sagging. Is this from the Botox? (photos)

Hi, this may be ptosis of the brow or lid which is a known side effect from Botox. It may mean the dose or injection technique needs adjusting. Please consult a medical practitioner for a face to face assessment. Kind regards, Dr Ana. Kat & Co Aesthetics

Unfortunately, it is difficult to make a thorough assessment without before photos to compare. I can tell you that Botox injections require precision both in terms of dosing and placement to achieve an optimal outcome. If your eyelid sagging occurred after your treatment, it is possible the placement of the Botox caused the problem. I encourage you to schedule an in-person consultation with a board-certified dermatologist who is also an expert Botox injector. Through an assessment and discussion of your concerns, you should be able to determine whether Botox was the culprit and if you need additional treatment to reverse the sagging. Good luck to you!

Too much Botox can cause this sagging, but it's hard to say if your concerns are related to your treatment. If issues occur they typically would be seen prior to eight weeks post treatment since Botox is in full effect after two weeks. Botox effects are temporary, generally lasting three to four months. So if it is from the Botox you should begin to see improvement soon.

A quick comparison of before and after photos will determine if the heaviness is due to Botox treatment. If too much Botox was injected into your forehead, then it is certainly possible that this is related to the Botox treatment. 

I generally agree with the other responses. However it is well known that Botox injection in the forehead can lead to brow ptosis or sagging of the brow. Brow ptosis can cause a more loose upper eyelid skin which may case it to drape differently over your kid. However I would expect this to happen as soon as the Botox takes affect (5-7 days) and then improve over time. Something that happens at 8 weeks is less likely to be from the Botox injections. 

It would be helpful to see your before photos as well, but after 8 weeks, any new eye changes should be evaluated. While Botox can cause some initial local swelling, it would be unusual for a sudden change. From your photos, it is difficult to ascertain any swelling although the eyelid skin sagging is readily apparent. It also appears that you may have had previous eyelid surgery. Botox would not cause eyelid skin to change, but it can accentuate the sagging skin that is already there if you are not elevating your eyebrows as much as prior to the Botox injections. In any case, I would recommend seeing your eye doctor for any sudden changes in your eyes.Best wishes,Pamela Stuart, MD

Thank you for your question and for sharing your photographs bob90. 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 and without knowing the dose used and the exact placement of the product. However, I hope the information provided here is useful.If I had a patient with the concern described here I would say that puffiness 8 weeks after a Botox has nothing to do with the Botox treatment. More likely it is an allergic response, especially this time of year. I would also want to see before pictures for comparison. A variety of treatments could address loose skin around the eyes.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!

Dear UK,Thank you for the question.Botox can have some local swelling initially, but 7-8 wks out I might consider an eye exam to rule out other causes of eye lag.Best.Dr Brecht Seattle, Wa