Eyebags Worse After Botox?

Question

Will Botox to crows feet make the bags and lines under the eyes look worse, as they  were not treated before? I have heard that Botox to crows feet will emphasize the under eye since they're not treated.

Brent Moelleken, MD · Answer

Botox, when placed in the crow's feet can have several unintended consequences.
First, eye bags can worsen.  This is due to relaxation of the orbicularis muscle, causing the fat bag retained now only by the orbital septum to bulge.
Second, the cheek can droop, by the same mechanism of relaxation of the orbicularis, causing descent of the cheek.
Fortunately, both these problems are predictable and can be pointed out to the patient beforehand.  Sometimes, the patient must make a choice of having the bags worsen or of having less relief of crow's feet.
This type of problem tends to be more of an issue as the patient gets older and begins to require blepharoplasty or a cheeklift to address their problem more definitively.
A board certified plastic surgeon skilled in both the above procedures, as well as in the administration of botuminum toxin, can advise the patient on when it may be time for a modified version of the Botox injection, or if surgery will be necessary to reduce their concerns.

Ron Shelton, MD · Answer

As there is improvement with anything cosmetically, other non treated areas may start to bother that person because the most bothersome areas now look better. Most people who undergo Botox for the Crow’s feet are happy with their results regardless of still having wrinkles under the lower eyelids. Resurfacing can help these lines and it is worth discussing this with your physician

Farbod Esmailian, MD · Answer

Any time you treat an area in a cosmetic fashion, you can partially over emphasize areas that have wrinkles.  So in short yes you can make the wrinkles under your eyes more prominent, but it is not because they have gotten worse, just more obvious.
Good luck.

Theda C. Kontis, MD · Answer

Botox is a wonderful treatment for crows feet--those lines that extend radially from the corner of the eye when smiling. Botox relaxes the muscle that surrounds the eye, which results in diminished wrinkling of the skin when one smiles.
I have seen, in a few patients, excellent results from Botox in improvment of the crows feet, but accentuation the wrinkles under the eyes. In select cases, Botox can be placed under the eye, but this may result in lowering of the eyelid rim. Sometimes I have recommended that these patients stop receiving Botox to the crows feet due to accentuation of the wrinkles under the eyes. Occasionally, I recommend a chemical peel to the skin of the lower lids to improve these wrinkles. Treatment is really tailored to the individual's needs and orbital anatomy.

Kenneth D. Steinsapir, MD · Answer

Dear Sara
This is absolutely reported. The botox injected for the crows feet area can drift, weakening the orbicularis oculi muscle below the eye in the outer lower eyelid. This causes the muscle to sag resulting in a little "bag" at the top of the cheek or a worsening of a preexisiting malar bag or festoon. It does not take a whole lot of BOTOX to create this effect. The effect is avoided by carefully controlling how the BOTOX is placed.

Tanveer Janjua, MD · Answer

Yes, it is expected. Botox relaxes the muscle that holds the fatty bags pushed in. This causes worsening of the bags for about one to two weeks. Typically after 2 weeks the muscle starts pushing the bags back inwards.
If you received a very small dose then your bags will go back in soon. If it was a higher dose then it might be a few months.
Regards

Houtan Chaboki, MD · Answer

Sara,
No.
Botox should not worsen eyebags of the lower eyelid. Bags of the lower eyelids are generally due to fat that gradually protrudes with age & sagging of the skin & muscle. Botox Cosmetic is generally applied to the sides of the eyes to treat Crow's feet wrinkles, between the eyebrows, and forehead area. There are other less common areas of the face & neck where Botox cosmetic may be applied. Best of luck.

Keith Denkler, MD · Answer

This recently happened to one of my patients.It seems on exam to be from loss of some of the pumping action of the lower eyelid muscles.Had 10 units to lower crows feet out laterally by and experienced injector and Allergan Botox trainer.The
 edema improved rapidly and to my patients satisfaction with 20 units of
 Vitrase to right lower eyelid edema and 10 units to left lower eyelid 
edema.Thanks to Realself to allow me to research the problem and come up with a solution.Keith Denkler MDSan Francisco Bay Area Plastic Surgery Larkspur, CAClinical Professor of Plastic Surgery, UCSF

Maurice M. Khosh, MD · Answer

Botox injection into the crow's feet area can THEORETICALLY cause the bags under the eyes to look worse. This is due to the fact that the orbicularis muscle (the circular muscle around the eye) helps push the fat back, and weakening the muscle can interfere with that action.
However, in reality, I have not seen any patients who have experienced increasing eye bags due to Botox injection into the crow's feet area.
The problem of increasing fat bags after Botox injection is more probably an optical illusion. As the aging signs are removed from the crow's feet region, the lower eyelid may appear older looking.

Hassan Galadari, MD · Answer

Too much of a good thing can do that. If Botox was injected in the lower eyelid and there was already loose lag skin due to the process of aging then yes that can be problematic as the muscles that are keeping the fat pads in place because relaxed. That can cause the appearance of bagginess to happen. Also, smile lines that area at rest can become more prominent if the crow's feet were treated. Those lines generally do not get better with Botox injection.
The dermatologist should be able to tell you whether Botox under the eyes may or may not be the right thing for you and will inform you what the possible effects can be.