LAM FACIAL PLASTICS

Hello Dr. Lam, thanks for this forum..it's very informative. I had Botox done for crowsfeet and now have extremely puffy undereyes. When I smile it gets all wrinkled and crepey looking...just horrible! I am so embarrassed, it's very noticiable. I look quite a bit older which is not what I expected! It has been four days since the injections, is it going to be like this until it wears off? I have never heard anything like this nor can I find anything about it on the Internet. Can you comment? Thank you, Kikibee

Yes, Botox around the eyes is both an art and a science. Also, trying out Botox on you first and making adjustments are important. Let's divide the problem into two ways that Botox may have been injected:
1. BOTOX INJECTED ONLY ON THE OUTER PART OF THE EYELID. If this is the case, then the remaining orbicularis oculi muscle under the eye may be moving against the frozen outer part of the eye to create this shelf or jelly roll under the eye. This would be treated by putting Botox right under the eye to soften the muscle (but would worsen the condition if you have #2 below). Usually problem #1 is only seen during smiling.
2. BOTOX INJECTED BOTH ON THE SIDES OF THE EYES AND A BIT TOWARD THE MIDDLE. Okay, now you may have one of several problems:
a. If Botox was injected immediately under the eye in someone with a mild fat bag and weak muscle tone, the muscle may relax and cause the eyebag to be bigger. There is no treatment for this except time. If this is the problem, you should not have Botox placed too close right under the eye. the other reason to avoid this type of injection is injecting Botox really close to the nose wrinkle can weaken the orbicularis muscle that surrounds the lacrimal sac (tear duct) and cause dry eye temporarily.
b. If Botox were injected into a festoon or malar bag, the area can enlarge either due to a weakeed muscle or aggravation of a malar bag. Some people have an area on the upper outer cheek near the eye that has abnormal looking skin that cyclically gets bigger in the morning or with salt intake. That person should not have a needle injected near the bag. For type 2 problems (both a and b), the abnormality is typically seen whether you smile or you don't.
I have had almost all of these problems with Botox and lecture about Botox all the time as well. However, I would not be scared of Botox but just make sure that your injector knows all of the above stated conditions well enough to help you and to modify the injection for you in the future.

I leave you with this thought that I always say, "If you like my Botox too bad it will go away. If you hate my Botox, don't worry it will go away."
best,
SML

Thank you Dr. Lam..that makes me feel better to have the explaination but also not I think it's a version of problem number 2...both a and b unfortunately. I didn't choose problem 1 b/c the injections weren't near the eyelids, more out along the boney area around the eye sockets. Injections were from outer corners to near the middlle. It's the middle injections that seems to have caused the "shelf" problem/ dry eyes and the abnormal puffy area on my cheekbone (malar bag?). I'll let the MD know what you said so we can avoid this in the future. I certainly don't want to look like an old bag for three months the next time !

I will avoid all salt, am using tea bags and ice on my eyes and will hide behind glasses or sunglasses for 3 months... trust me it's necessary. Thank you so much for your prompt reply, I truly appreciate it! Have a great weekend!

No problem. Your physician probably knows all of that already. I am glad that I could be of help.
Best wishes,
SML