Puffy Eyes After Botox? What Causes It and How to Fix It

Woman with under-eye swelling after Botox treatment

Why Do My Eyes Look Puffy After Botox?

If you’ve noticed puffiness under your eyes after Botox, especially in the mornings, you’re not alone. It’s something we occasionally see after treating crow’s feet, and while it can be a surprise, it’s a completely manageable side effect. Let’s break down what’s happening, why it occurs, and how we can prevent it in the future.

What is Malar Oedema?

The puffiness you’re seeing is called malar oedema. It’s a mild swelling that occurs under the eyes when fluid collects in the tissue. In some people, this can become visible after Botox to the crow’s feet area. Why? Because of how Botox works.

Botox relaxes the muscles responsible for crow’s feet, particularly the orbicularis oculi, which acts like a muscle pump. When this pump is switched off, the underlying lymphatic system (your body’s fluid drainage network) can be revealed as sluggish, and fluid begins to pool under the eyes.

Why Does It Happen to Some People?

Some people are more prone to this effect than others, particularly if they naturally have slower lymphatic drainage in the under-eye area. Normally, the active eye muscles help mask this sluggish drainage by assisting with fluid movement. But when Botox relaxes those muscles, the fluid can no longer be efficiently pumped away—and that’s when the puffiness becomes more noticeable.

Why Is It Worse in the Morning?

After lying flat overnight, fluid tends to pool in the head and neck, especially under the eyes. This is why you may notice puffiness is worse when you first wake up, and improves throughout the day as gravity helps the fluid drain away while you’re upright.

What Can You Do About It?

The good news is that this puffiness is temporary and there are some very effective ways to manage and reduce it:

1. Lymphatic Drainage Massage

Gently tapping or massaging the area under the eye can help move the fluid along your lymphatic pathways. Think of it like milking a hose pipe: you’re encouraging the fluid to move outwards and down your face and neck.

You can also use tools like a jade roller to assist, but be sure to avoid pulling or dragging the skin.

2. Sleep Slightly Elevated

Sleeping on two pillows can help reduce overnight pooling by keeping your head above your heart, allowing fluid to drain more effectively.

3. Watch Your Salt Intake

A high-salt diet can cause your body to retain more fluid, making puffiness worse. It’s worth reducing your salt intake if this has been a recurring issue for you.

4. Avoid Antihistamines

This puffiness is not due to an allergic reaction, so antihistamines won’t help here.

What Are the Options for Future Botox Treatments?

If this side effect has occurred, we can tailor your future treatments to help prevent it. Here are three personalised options we might explore:

1. Avoid the crow’s feet area altogether.
   This keeps the muscle pump fully intact, preventing the issue entirely, but it does mean we won’t treat lines in this area.

2. Skip the lowest injection point.
   This gives a smoother look around the upper part of the crow’s feet while preserving the muscle pump at the lower corner of the eye.

3. Lower the dose in the lower crow’s feet area.
   This can reduce lines while still allowing some muscle activity to assist drainage. Mild puffiness may still occur, but typically resolves as the Botox begins to wear off at around 6–8 weeks.

In Summary

While malar oedema after Botox can be frustrating, it’s a known and manageable side effect that we’re very familiar with at Fresh Aesthetics & Skin. This is not a sign of anything going wrong, it’s simply your body's natural drainage system adjusting to relaxed muscles. With the right techniques, it can be quickly reduced, and future treatments can be adjusted to suit your unique anatomy.

If you have any questions or are experiencing under-eye swelling after your Botox treatment, please don’t hesitate to get in touch. We're here to help you feel confident, informed, and in control of your aesthetic journey.

Ready to personalise your Botox treatment plan?
Book a consultation with Dr Jayne or Dr Brian today and let’s explore what works best for your face, your lifestyle, and your goals.