Dr. Sam Lam Plastic Surgery Forum

I read that some people can get droopy lower eyelids after Botox injections to treat crows' feet, with the droopiness lasting a few months until the Botox wears off. What are your feelings about (and have you ever seen) this reported droopy lower eyelid side effect?

Also, do you ever use Botox for creases right under the eye caused by, I guess, expressions like smiling made repeatedly over a long time? Is it effective in that area?

Finally, do you advise your patients to avoid any particular activity (such as exercise) after getting Botox injections?

I read that some people can get droopy lower eyelids after Botox injections to treat crows' feet, with the droopiness lasting a few months until the Botox wears off. What are your feelings about (and have you ever seen) this reported droopy lower eyelid side effect?
I BELIEVE THIS CAN HAPPEN. I GET IT RIGHT IN 98% OF THE CASES BUT A FEW TIMES I HAVE SEEN THIS. I CHECK FOR LOWER EYELID TONE AND EYELID POSITION BEFORE DOING BOTOX IN THE LOWER EYELID AREA. BASICALLY, IF YOU HAVE HAD A SKIN BASED LOWER EYELID BLEPHAROPLASTY THEN YOU MIGHT BE AT A RISK FOR THIS PROBLEM. IF YOU ARE OLDER WITH POOR LID TONE OR HANGING OF THE LOWER EYELID ALREADY THEN YOU ARE ALSO AT RISK. I TRY TO CHECK FOR THESE PROBLEMS BEFORE HAND. IF YOU DON'T HAVE THESE ISSUES, THE CHANCE OF HAVING A LOWER EYELID ISSUE FOLLOWING BOTOX IS EXTREMELY LOW. AS WITH ALL BOTOX, ANY PROBLEMS GO AWAY OVER TIME.

Also, do you ever use Botox for creases right under the eye caused by, I guess, expressions like smiling made repeatedly over a long time? Is it effective in that area?
YES, I DO. I GET RIGHT UP UNDER THE EYE IN ABOUT 50% OF PATIENTS. MANY PEOPLE WHO SMILE TORQUE UP INTO THE LOWER EYELID AND I PUT BOTOX THERE TO HELP. STILL OFTENTIMES CREAMS AND OTHER TREATMENTS MAY BE NECESSARY IN COMBINATION WITH BOTOX FOR MAXIMAL BENEFIT.

Finally, do you advise your patients to avoid any particular activity (such as exercise) after getting Botox injections?
YES, ONLY THE DAY OF. THE NEXT DAY ALL IS GOOD. I ASK THEM TO EXERCISE BEFORE THE BOTOX NOT AFTER. THE MAIN AREA THAT I AM WORRIED ABOUT IS BETWEEN THE EYES FOR THE GLABELLAR FROWN LINES. THIS IS AN AREA THAT YOU CANNOT UNDER ANY CIRCUMSTANCES WORKOUT THAT DAY. THE REASON IS THAT SWEATING AND WIPING THE FOREHEAD MAY PUSH THE PRODUCT WHERE I DID NOT INTEND AND CAUSE AN EYELID DROOP.
best,
sml

Hi there,
7 months ago I had botox between my eyebrows, crows feet, bunny lines on the ridge of my nose and just under my lower eye lashes. My face was very paralyzed. About 3 weeks later, I noticed severe eye strain and then overnight, my eyes completely dried out. No fluid at all. I had severe corneal abrasions. The botox dr told me over the phone I probably had an autoimmune disease when I told her how severely dried out my eyes were. Prior to this, my eyes were only dry if I had a fan heater blowing in my face. Nothing else dried my eyes out. I had my blood tested on several occasions for various autoimmune diseases and they were negative. I insisted the Botox dr see me and when she did she was extremely dismissive and said that although she's never experienced a patient with this problem before, it could stop sweating so presumably it could dry the eyes out. I have since had punctal plugs inserted, have been using lubricating drops every 5 minutes with NO relief and have been on strong steroid drops. Last week, I started Restasis. I have been severely incapacitated since 4 Feb 2010 when I had this injected. The Botox dr had never put it into my lower lids before. An eye specialist observed that when I was blinking, my eye lids weren't closing properly. Is it possibly that could have caused this horrible situation with my eyes and I am also wondering if she put so much in around my eyes if it somehow paralyzed my lacrimal gland. I have gone from a very vibrant 43 year old to a person with a high disability and cannot leave the house as the pain in my eyes is too much. I also now have depression. I am hoping someone can validate that it was the botox and give me hope that things will eventually come good for me. I am in perfect health apart from this.
Kind regards

hi,
really sorry to hear that. i have treated probably over 10,000 injections and never have encountered this. i think with any product there is always a possible risk. it could be related and it might not be. hard to really say. i would check with maybe an Internist to check your whole body's diseases just to make sure. i would also have it reported to Allergan, the company, just in case they need an Adverse Event profile record. Out of curiosity was it done in the United States? Sometimes people do not use Botox but a competing brand of BTX. Here in the U.S. there are only two brands that are FDA approved Botox and Dysport. However, in other countries there are impure versions or I should say differently made versions like in China, Japan, Germany, etc. Make sure your doctor was using Botox brand and it was legitimate. Botox brand is very very very very purified and safe. It must have a hologram on the side to be real. Check all of that too. Allergan will probably check with your doctor's office to make sure that he is using real, FDA approved product if you report an AE to them.
best,
sml

Thanks for your reply. I had the Botox done in Australia. Out of curiousity, why is it that on a lot of websites they say botox can give you dry eyes? Or are mine just so severe that it seems unlikely it was the botox.

Kind regards

i think it is a possible side effect most likely at high doses. i have never seen that side effect. again, please check with your physician on what type of BTX he used. it may not have been Botox brand. if it was, you should report any of your AEs to them.
best,
sml

I am so appreciative of your prompt reply. My suspicions are the dr used an awful lot of botox. When I called her originally she was so dismissive so I hope I am able to get some honest answers from her next time. I really doubt I have other diseases going on as I have had several tests already. I am hoping for a miracle as this has been such an awful thing to live with. I will give you progress reports.

Once again, so grateful for your response.
Best wishes,
Chloe

my pleasure to help even though it is very small. please try to get her to report this to the company that manufactured it. it is very important that you do that service for other prospective patients. unfortunately, i really only trust the FDA approved products that we have here in the States. A few years ago we had a similar scare but the doctors were not using FDA approved products. what you are describing you should see an Internist too. it is important that you don't blow off the symptoms.
best,
sml