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Puffy Under Eyes After Botox?
If you still have swelling after two weeks, it is unlikely that the swelling is due to the volume of the fluid or edema. It is much more likely that there has been a moderate amount of paralysis to your orbicularis oris muscle. This muscle is circular and sits on top of your bony orbit. Paralyzing the muscle can cause increased prominence of undereye troughs as the muscle tone helps keep this area tight. It will require time to allow the botox to wear off.
Clinical Context
This is easy to confuse with two other things: true fluid swelling from an allergic reaction, and the puffiness some people get from filler placed too near the orbital rim. Allergic swelling usually shows up within hours and often comes with redness or itching. Filler-related puffiness tends to persist unchanged until dissolved. Botox-related prominence is different—it develops gradually as the muscle relaxes, stays fairly stable, and resolves on its own as the treatment wears off, typically over a few months rather than days.
