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1:34 • Published 31 Oct 2026 • Dr Ed Robinson
Why Can Botox Cause Puffy Under-Eyes?
The short answer
The orbicularis oculi muscle around the eye causes crow's feet, but it also works as a pump that clears fluid from under the eyes. If toxin relaxes it too much, that pump works less well, fluid can build up and the under-eyes can look puffy. For people prone to under-eye swelling, a much lower dose, or leaving the area alone, may be the better choice.Founder and Medical Director • Last reviewed 1 November 2026
In brief
Key Takeaways
- 01The orbicularis oculi muscle wraps around the eye and scrunches it up tight. Over time, repeated movement and loss of collagen and elastin lead to crow's feet.
- 02Toxin placed in the outer part of this muscle reduces its activity and softens crow's feet, but it needs cautious dosing.
- 03Over-relaxing the muscle can cause sagging under the eye.
- 04The same muscle acts as a pump for lymphatic fluid under the eyes, which is why under-eyes often look puffier first thing in the morning.
- 05If you are prone to under-eye swelling, it may be best to use a significantly reduced dose or avoid treating this area.
Dr Ed Robinson explains
The Detail
Puffiness under the eyes after Botox is something we are asked about regularly. In this video Dr Ed uses anatomy to explain why it happens and how we try to avoid it.
The muscle behind crow's feet. The orbicularis oculi is a ring of muscle that wraps around the eye and lets you scrunch your eyes up tight. With repeated use over the years, and as the skin loses collagen and elastin, lines start to form on the outer corner of the eye. These are crow's feet.
How toxin softens them. Placing toxin in the outer part of the orbicularis oculi reduces the muscle's activity, which softens the lines. Dosing here needs to be cautious, because over-relaxing the muscle can cause sagging under the eye.
Why puffiness can happen. The orbicularis oculi also works as a pump for the lymphatic fluid that collects under the eyes during the day. That is part of the reason your under-eyes can look puffier when you wake up: the muscle has been resting while you sleep, and lying flat lets fluid build up. Once the muscle is relaxed with toxin, the pump is less effective, fluid can collect and the area can look swollen.
Who should take extra care. Some people are simply more prone to under-eye swelling, because of anatomy, genetics, hormones, lifestyle, diet or allergies. For them, Dr Ed's view is that it may be best to avoid treating this area entirely or to use a significantly reduced dose. People have treatment to look and feel better, so a plan that risks looking worse is not the right plan.
Unwanted toxin effects are temporary. Most settle sooner, but they can take up to 4 months to wear off. At your consultation we look at your eye area, your history and any tendency to swelling before suggesting whether, and how, to treat it.
Video transcript
Edited from the video captions.
I'm an aesthetics doctor, and if you've ever had puffiness here following Botox treatments, I'm going to tell you why and how you can avoid it. And if you're new here, in a world where aesthetic treatments can be very confusing, I like to use anatomy to explain what does and doesn't work. So, let's get into it. The orbicularis oculi muscle that I've drawn here in green wraps around your eye and is responsible for scrunching up tight like that. Over time, through repetitive muscle use and as we lose collagen and elastin in our skin, we start to develop these crow's feet on the lateral or outer aspect of the eye. When toxin is placed in the lateral aspect of the orbicularis oculi muscle, it can be used to reduce the muscle activity and therefore soften these lines. It's actually really important that toxin is cautiously dosed in this area, because over-relaxing these lines can cause sagging under the eye. However, when we're looking specifically at puffiness that happens, this is because the orbicularis oculi muscle basically acts as a pump for the lymphatic fluid that accumulates under the eyes throughout the day. This is also why when you wake up in the morning, you tend to have puffier under-eyes, because this muscle hasn't been active while you've been sleeping, and you've also been horizontal, meaning lymphatic fluid builds up. Once you've relaxed this muscle with toxin, the ability of this muscle to act as a pump is reduced, making it less effective, allowing fluid to accumulate, and it doesn't look good. Generally, when people are having a treatment done to make themselves look and feel better, if you look worse as a result, they tend to be unhappy. So, for people who are prone to under-eye swelling, and this might be because of anatomy, genetics, hormones, lifestyle, diet or allergies, it may well just be best to avoid treating this area entirely, or using a significantly reduced dose.
Questions
Frequently Asked Questions
Why are my under-eyes puffy after Botox?
The muscle around the eye helps pump fluid away from the under-eye area. If toxin relaxes it too much, that pump works less well and fluid can collect, which can look like puffiness or swelling.
Is puffiness after Botox permanent?
No. Unwanted toxin effects are temporary. Most settle sooner, but they can take up to 4 months to wear off. If you are worried about any change after treatment, contact the clinic so we can review you.
Who is more likely to get puffy under-eyes after treatment?
People who are already prone to under-eye swelling, for example because of anatomy, genetics, hormones, lifestyle, diet or allergies. For them a much lower dose, or not treating the area, may be best.
Why do my eyes look puffier in the morning?
While you sleep, the muscle around the eye is not active and you are lying flat, so lymphatic fluid can build up under the eyes overnight.
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