Botox Under Eyes

12 sources cited
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What is Botox?

Botox, also called OnabotulinumtoxinA, is a neurotoxin produced from the bacteria Clostridium botulinum. It is commonly used as an injection to reduce the appearance of facial wrinkles and diminish signs of aging.

Botox is a non-invasive, cosmetic procedure that has increased over the years, with 4.4 million Botox injections in 2020.1 

While the cosmetic use of Botox is widespread, it is currently only approved by the Food and Drug Administration (FDA) for three cosmetic procedures:

  1. Glabellar lines (frown lines)
  2. Crow’s feet
  3. Horizontal forehead lines 

Botox is also FDA-approved for non-cosmetic uses to help relieve the symptoms of:

  • Chronic migraine
  • Overactive bladder
  • Cervical dystonia (involuntary contraction of neck muscles)
  • Spasticity (abnormal muscle tightness)
  • Axillary hyperhidrosis (severe underarm sweating)
  • Strabismus (crossed eyes)

While Botox is the most popular procedure, there are other commercially manufactured products that use the botulinum bacterium to reduce the signs of aging. They include:

  • RimabotulinumtoxinB (Myobloc)
  • IncobotulinumtoxinA (Xeomin)
  • AbobotulinumtoxinA (Dysport)
  • PrabotulinumtoxinA (Jeuveau)

How Does Botox Work?

When injected, Botox paralyzes and weakens facial muscles by blocking nerve signal receptors (preventing release of acetylcholine) that promote muscle contraction. This procedure can help people with nerve disorders and enhance the appearance of smooth skin.

While botulinum is poisonous in large amounts, Botox injections only use small and weakened doses of the bacteria. They are proven to be safe and effective at treating facial wrinkles and other nerve disorders.

Although rare, some people develop antibodies (immune response) to Botox, reducing its effectiveness over time.5 

Can Botox Treat the Under Eye Area?

Many dermatologists and certified plastic surgeons use Botox for off-label (not FDA-approved) procedures. These include using Botox under the eyes to smooth the appearance of fine lines, treat dark circles, and reduce eye puffiness and dark circles, and add volume. 

Because using Botox under the eyes is not FDA-approved, it is only done at the medical professional's discretion.

Some doctors avoid administering Botox injections under the eye because it can cause unwanted sagging, bagging, and trouble blinking. The skin under the eyes is also thin and fragile, so extra precaution is warranted.

Three pictures compared effect Before and After treatment. under eyes with problems of dark circles and wrinkles periorbital before and after treatment to solve skin problem for better skin

Effectiveness

There haven't been many clinical trials or research studies investigating the safety and effectiveness of getting Botox injections under the eyes. However, a 2003 study of 19 women found lower eyelid Botox injections reduced wrinkles and fine lines.7

Evidence has shown that eight units of Botox give the best results for under-eye treatment. This amount also comes with the most side effects, including lower eyelid swelling.7 

Procedure 

Botox injections are a medical procedure administered with a narrow micro-needle by a board-certified botox doctor, dermatologist, or field specialist. They usually occur in a doctor's office and take less than 15 minutes.

Before getting Botox injections, a medical professional will ask about medical history and current medications. This is to ensure Botox does not negatively interact with medication or cause health complications. 

Some medical professionals use a topical numbing cream to reduce discomfort. Botox injections feel similar to a pinch but do not usually hurt.

The number of injections will depend on what areas of the face require treatment. For example, crow's feet usually require two to three injections, while browlines typically require five or more. 

What to Expect

After receiving Botox injections, you can resume normal activities. There is no recovery period. You will not lose any sense of feeling. 

Because Botox targets the muscles, it can affect natural facial expressions. With specific dosing in targeted muscles, trained professionals can minimize muscle weakness and promote a natural look. 

After getting Botox injections, you should avoid:

  • Rubbing or massaging the area
  • Strenuous physical activity (anything that raises your heart rate) for 2 hours
  • Lying down for 4 hours

People typically see results 3 to 7 days after treatment. The injections last 3 to 6 months and can be repeated when wrinkles come back. 

Outlook

Because under the eye Botox injections are not currently FDA-approved and have limited research on safety and effectiveness, proceed with caution. Always discuss the risks and benefits with a medical professional.

In general, when used as specified, Botox injections reduce wrinkles and signs of aging. 

Botox Safety Considerations

There have not been any reported life-threatening side effects of Botox injections. Medical professionals continue to prioritize safety with continued research and medical education for those who are licensed to administer Botox.

Side Effects of Botox 

Some people might experience side effects from Botox, especially because the under-eye skin is thin and delicate.

Common side effects include:

  • Lower eyelid swelling
  • Eye puffiness
  • Redness
  • Numbness
  • Sagging and drooping
  • Trouble closing the eye

Risks of Botox

Common risks of Botox include:

  • Bruising at the injection site
  • Flu-like symptoms
  • Headache 
  • Nausea 
  • Dry mouth
  • Drooping eyelids

Who Shouldn’t Get Botox Under Their Eyes

To get Botox injections, you must be healthy and at least 18 years old. 

Botox injections are not recommended for people who have:

  • Neuromuscular disease, such as myasthenia gravis
  • Facial muscle weakness
  • Deep facial scars
  • Drooping eyelids

Botox injections are also not recommended for people who are pregnant, think they are pregnant, or planning to become pregnant.

How Much Does Botox Cost?

Insurance typically does not cover cosmetic Botox injections, so people usually pay out of pocket.  

On average, Botox injections cost between $250 and $1,000 depending on the number of injections, clinic type, and location.11 

Alternative Treatments 

Botox injections are not the only way to reduce the appearance of wrinkles, fine lines, and dark circles under the eyes.

Dermatologists and other medical professionals also commonly use hyaluronic acid fillers, also called dermal fillers, which reduce the appearance of wrinkles and fine lines under the eyes. 

While Botox freezes muscles, fillers add volume and fullness to thinning skin, minimizing the signs of aging. 

Homeopathic and positive lifestyle changes can also slow the signs of aging and promote smoother and younger skin. Botox alternatives include:

  • Drink lots of water
  • Avoid foods high in sodium
  • Get plenty of sleep
  • Apply sunscreen regularly
  • Avoid smoking 
  • Limit alcohol consumption 
  • Treat seasonal allergies with antihistamines 
  • Use anti-aging eye creams

Laser treatments are also an alternative therapy for under the eye. However, they can be expensive. 

Summary

Botox is a neurotoxin called Onabotulinumtoxin A produced by the bacteria Clostridium botulinum. It is used to freeze muscles and prohibit muscle contraction while reducing the signs of aging, including the disappearance of facial wrinkles and fine lines.  

Getting Botox under the eyes is not FDA-approved and lacks clinical research to determine safety and effectiveness. However, many licensed and trained medical professionals use Botox injections for off-label purposes, including under the eye injections. 

Botox injections are administered in a doctor's office or clinic using a micro-needle. Injections typically take about 15 minutes. The number of injections is determined by what areas of the face need to be treated.

Results take 3 to 7 days and last 3 to 6 months. Injections can be repeated when facial wrinkles and fine lines return.

12 Cited Research Articles
  1. American Society of Plastic Surgeons unveils covid-19's impact and pent-up patient demand fueling the industry's current post-pandemic boom.” American Society of Plastic Surgeons. 
  2. What does an FDA approval mean for cosmetic treatments and devices? American Society of Plastic Surgeons. 
  3. FDA approves expanded Botox® (onabotulinumtoxina) label for the treatment of pediatric patients with spasticity.” AbbVie
  4. Strabismus: Botox Treatment.” American Academy of Ophthalmology. 
  5. Naumann, M., Boo, L., Ackerman, A., Gallagher, C. “Immunogenicity of botulinum toxins.” Journal of Neural Transmission. Ltd, 25 Sept. 2012
  6. Botox around the eyes and its results.” American Society of Plastic Surgeons.
  7. Flynn, T., Carruthers, J., Carruthers, A., Clark, R. “Botulinum A toxin (BOTOX) in the lower eyelid: dose-finding study.” Dermatologic Surgery. Ltd, 22 Aug. 2003
  8. What are the steps of botulinum toxin injections?” American Society of Plastic Surgeons.
  9. Botulinum toxin therapy: FAQs.” American Academy of Dermatology Association. 
  10. Botulinum toxin (Botox) for facial wrinkles.” American Academy of Ophthalmology.
  11. Cosmetic surgery pricing.” American Board of Cosmetic Surgery.
  12. Botox vs fillers: which one is best?” Eternal Dermatology and Aesthetics.
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