Upper Blepharoplasty After Botox?

I get Botox to treat my crows feet every 3 to 4 months (for the past year). I would like to have upper eyelid Blepharoplasty to reduce baggy skin in my upper eyelids. I have heard that treating crows feet with Botox can create a temporary brow lift and reduce some of the redundant skin in the upper eyelid, and therefore it is best to have all the Botox worn off before doing an upper Blepharoplasty.

On the other hand, I have heard that having the Botox in the eye area prior to upper Blepharoplasty can be positive, since it reduces movement during healing and can help improve scar appearance. When is the best time to have an upper Blepharoplasty following Botox for crows feet? If it is best to let the Botox wear off, is 4 months sufficient time for the effects of Botox on lifting the brow to wear off, or should I wait 6 months before undergoing Blepharoplasty surgery?

Doctor Answers 16

Timing of upper blepharoplasty, forehead lift, and Botox

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It depends on your reasons for the Botox.

If the only reason you get Botox is for the crow's feet than it should not really effect the upper blepharoplasty and I would proceed.

If you get Botox because of the forehead lift secondary effects you may want to consider a transblepharoplasty browpexy or a browlift procedure with your upper lid blepharoplasty.

There are many reasons for a browlift. Occasionally excess upper lid skin can cause you to compensate by using your forehead muscles to lift the skin out of your line of sight. Many people notice that their forehead lines ease when they have a upperlid blepharoplasty because their forehead doesn't have to work so hard to get the skin out of the way.

I would discuss this with your surgeon who can review your anatomy and concerns. In my opinion, however, I would wait the 4 months.

Chicago Plastic Surgeon
4.9 out of 5 stars 86 reviews

Prudent Botox use helpful for forehead lifts and blepharoplasty

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Thanks for your question.

I find that the prudent use of Botox iseful for forehead lifts and eyelid tuck procedures (blepharoplasty). Botox is typically administered at least 3-4 weeks prior to the procedure. Botox is administered to reduce the pull or tension of key muscles to assist in optimizing the healing phase.

Botox may be helpful for scar control. This would be used in areas where the underlying pull of the muscle is placing tension on the wound (scar). Whether it would be effective for you requires a thorough examination.

Typically, the exam should be performed without the effects of Botox on board for 4-6 months. Photographs are taken at that time to document your physical state and used at the time of surgery. I would advise you to make an appointment with a board certified/eligible surgeon that is experienced in facial rejuvenation procedures and Botox to discuss your options. I hope you find this helpful.

Stephen A. Goldstein, MD
Englewood Plastic Surgeon

Best to let Botox wear off

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In order to get a true read on your anatomy and what you would like surgery to achieve, you should let all effects of Botox wear off. Botox itself doesn't cause the eyebrow to raise up, it is where you place the Botox that does that. Botox is blind to what muscle it affects and each muscle around the eyelids and eyebrow has a certain job. Placing Botox in one muscle group can allow the eyebrow to elevate by relaxing the depressors while another muscle group will cause it to fall by weakening the elevators. How long to wait depends on each individual and can be assessed by you and your surgeon.

Incisions around the eyelid generally heal the best so I wouldn't place Botox just to effect the healing of the scar.

Robin T.W. Yuan, MD
Beverly Hills Plastic Surgeon


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I would highly recommend waiting until the effects from the BOTOX Cosmetic have worn off.  I would recommend waiting 4 months to ensure the effects of the BOTOX Cosmetic have decreased and you can proceed with surgery.

William P. Mack, MD, PA
Tampa Oculoplastic Surgeon
5.0 out of 5 stars 45 reviews

Botox and blepharoplasty

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It would be ideal to allow your dermatologic or plastic surgeon to see the eyelids in their natural state before having your surgery to avoid any problems. So, let the Botox wear off first before surgery.

Benjamin Barankin, MD, FRCPC
Toronto Dermatologic Surgeon

Botox and upper lid blepharoplasty

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Let the botox wear off before having surgery .  This should only take 3-4 months.  You can restart Botox after surgery when the incisions are healed.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Okay to have botox

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It is okay to have Botox either before or after a blepharoplasty and will not affect the results of the upper or lower eyelid blepharoplasty. Botox for crow’s-feet will not affect the results from blepharoplasty.

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 155 reviews

Wait if Botox was injected under lateral brow

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If you have had an under the brow injection of botox you should wait until the botox wears off. If your brows "lowered" after the botox treatment you should also wait.

Richard D. Gentile, MD
Youngstown Facial Plastic Surgeon
4.5 out of 5 stars 41 reviews

OK to perform Blepharoplasty with Botox in place

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You will know how much of a browlift you really received from Botox treatment of your crow's feet. Although it is best to have the Botox effects removed prior to blepharoplasty, in most cases, it is not a big issue. If you receive your Botox from the same surgeon who will perform your eyelid procedure, s/he will know anyway. Some patients get a dramatic (undesirable?) devil's peak effect of the brows after botox. In this situation, your surgeon will likely recommend holding off with the surgery until it has normalized.

Frank P. Fechner, MD
Worcester Facial Plastic Surgeon
4.6 out of 5 stars 50 reviews

If you will continue using Botox, you can have the blepharoplasty anytime.

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Hi! Presumably you like the results of Botox and will continue to get it every 4 months. So this is a stable situation.

In any case, if your eyebrows drop, the solution is NOT to take out more skin during the upper blepharoplasty. That just drags the brows further down. The solution in that case is a brow lift (there are several different kinds).

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

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.