When Will the Swelling, Puffy Eyelids Go Away?

Question

Eight days after my Botox injections my eyes became extremely swollen.  I applied a cold compress and the swelling went down considerably, but my eyelids are still puffy and its 11 days since my injections.  Is this going to go away?

David Shafer, MD, FACS · Answer

Sometimes after Botox people complain of "swollen eyelids."  This is most likely not swelling.  It is because the Botox was injected too close to the eyebrow.  It is no surprise that this happened 8 days after your injection, since this is when the Botox had finally started working (it takes 3 to 7 days for the Botox to take effect).  The eyebrow then drops (ptosis) and the skin between the upper eyelid and the eyebrow gets compressed into a smaller space - the distance between the eyebrow and the upper lid become shorter.
This makes the upper lid skin puff out since it has nowhere else to go.  So, I would recommend looking at your pre-injection photographs and compare the level of your eyebrows.  There is no solution for this except for time - 3 to 6 months for the Botox to go away.  This most often happens to patients only the first time they have Botox.
It is very difficult to predict which patients will have this response.  If you do have this response, then you will know the next time you have Botox to have it injected higher above your eyebrows.  This is a compromise, since you may be left with a wrinkle above your brow, but that is better than the dropped brows.

Harold J. Kaplan, MD · Answer

It sounds like either one of two things is going on:
1.  At around 8 days you achieved the full effect of Botox. When injected incorrectly it can cause a heavy or drooping brow which may look and feel like swelling, but is related to the brow moving downward which creates unusual pressure on the eyelids and eyes.
2.  If the Botox was injected correctly, it may be that your symptoms are unrelated to the Botox injections.
In either case, we suggest a visit to your practitioner to be evaluated. Good luck.

Michael A. Persky, MD · Answer

Hi Chriss,
Puffiness of the eyes is extremely rare after Botox injections. 
You should return to your injecting physician and be evaluated.  Since your symptoms began about 8 days after your injections (when the Botox took full effect), it is most likely that you are having weakness in the upper eye lid muscles.  Since it took some time to manifest, it will likely resolve quickly as the Botox loses effect. 
Let us know what your physician thinks.  Hopefully your symptoms will resolve rapidly.
Good luck and be well.
Dr. P

Monika Soni, MD · Answer

Thank you for your question! The swelling should have gone down within 1-2 hours after the initial Botox injection. What you are experiencing is unusual and should be evaluated by a physician to get a diagnosis. Perhaps since the Botox injections, you were exposed to some topical or airborne allergen. Best of luck!

Hardik Soni, MD · Answer

The swelling you are describing is due to where the Botox was injected. The Botox was most likely injected to closely to the eyebrow. Unfortunately there is nothing you can do now. The Botox will wear off in 3-4 months. I would still call your physician and have this evaluated.

Naveen Somia, MBBS, PhD, FRACS · Answer

It is unlikely to have swelling or puffy eyelids after Botox injections.A small group of people have reported mild reactions to Botox. These may be due to the proteins present in the formulation of the Botox. Try cold compress for the first 3 days and then alternate hot and cold compresses. A low salt diet and minimal exertion can help. If this happens again then you have your answer

William Portuese, MD · Answer

The swelling around the eyes related to Botox injections 11 days ago could be related to where the Botox was injected. Steroid pills may help with this, and a low-salt diet would also help. Cold and hot compresses 11 days after the procedure was performed will not do any good at this point.

Stella Desyatnikova, MD · Answer

It is unlikely that your reaction is actually related to Botox, since Botox itself is gone out of your system soon after the injection. The good news is that the swelling will likely to go away. You might need to figure out whether there are any other factors that may cause the swelling - new cosmetics, mascara, etc.
Talk to your treating doctor and go through the list. You might need a short term prescription as well to deal with the swelling,

Bryan K. Chen, MD · Answer

The swelling should have gone down within 1-2 hours after the initial Botox injection.  What you are experiencing is unusual and should be evaluated by a physician to get a diagnosis.  Perhaps since the Botox injections, you were exposed to some topical or airborne allergen.
Good luck.

When Will the Swelling, Puffy Eyelids Go Away?

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