Botox Under Eye Has Caused Huge Bags and Wrinkles

Botox is excellent for frown lines and crow's feet that appear around the eyes. For wrinkles of the lower eyelids, they may be from over-active muscles called the orbicularis oculi muscles. However, treating under-eye wrinkles with Botox can also make bags bigger. The lower eyelid is made up of skin, muscle, fat then a layer called the orbital septum then fat. If the septum is already weak, the only thing holding back the lower eyelid fat from bulging is the muscle; weaken that muscle and you get puffy eyes or bags.

I am careful to first dissuade then warn each patient I treat with Botox under the eyes. For those with little fat and excellent muscle tone, the results can be very rewarding, but all patients are also cautioned that bags can appear or look worse. Fortunately, Botox does wear off, but it takes a few months.

Without seeing you in person and examining you before and after the treatment it is not fair for any physician to comment on your specific situation. You did not state that the doctor injected below the eyelid, but at the corner of the eyelid. This is a common location for many physicians to inject but we don't know exactly how far from the orbital bone the insertions were.It is possible that you have unique anatomy so that the normal treatment given by many expert physicians who have commented on this panel could have seen a similar result. The photographs appear to demonstrate some protrusion of the lower eyelid fat pads and if you didn't have this before then fortuntately this is pseudoherniation of the fat pads and will resolve over time, a few months. The wrinkling might be from compensatory excessive contraction of the rest of the muscle below the eye that wasn't affected by the Botox.Although there is a possibility that Fraxel Restore or Pelleve may help reduce some of the wrinkling temporarily, there might be excessive swelling if your eyelid muscles are not working normally.

We are curious if you returned to your physician after the suggested waiting time to determine if there was improvement or helpful feedback from her.

Without knowing the details of your treatment, it would appear that the technique/dosing used may be responsible for your negative outcome.  For example, we do not inject below the lower eye muscle because of this concern.

Although it doesn't offer much comfort in the present, time will improve your condition.

Botox is a medication that should be injected in the crow's feet area of the eyes. The lower eyelid should be  avoided as one can weaken the lower eyelid muscles causing difficulty in the eyelids closing. From the pictures that I see, it would be difficult for me to comment as there is a difference in lighting. Generally speaking Botox does not cause bags . A baggy lower eyelid or an eyelid with many lines was probably present before the treatment was initiated.

Botox injected too deeply around the eyes can cause swelling under the eyes since relaxing the muscle pump in this area will cause fluid to accumulate.  Lymphatic drainage techniques offered by some aestheticians below the eyes may help.  Sleeping on a few pillows to elevate your head and cold steeped green tea bags may also help but you will need to wait a few months until the Botox effect wears off.  Next time, fewer units of Botox placed superficially should prevent this swelling.  Please have treatment with a dermatologist or plastic surgeon who is an experienced injector.

RaeCat,

I am so sorry to hear you are suffering with this unwanted Botox side effect. It is true that many doctors misunderstand the value and limitations of these treatments, and can cause unintended problems. Luckily, though it may not wear off in 7 to 10 days as you were told, at least it is not completely permanent.

The orbicularis oculi muscle (the muscle that controls eyelid closing and opening) is a circular band of muscle that goes all the way around the eye. If part of it is weakened TOO much, it can not only weaken the eye's ability to blink and close properly, it can weaken what I call the "squeegee" effect that normally works to squeeze excess fluid out from around the thin-skinned under eye area.

To improve this while you are waiting for the effect to wear off, lightly massaging the under eye skin outwards in a single direction motion several times per day may help to work excess fluid out of the area. Good luck and I hope you recover soon.

Unfortunately, some injectors who have limited knowledge and experience, seem to use botox as the answer to everything.  This is  a common pitfall.  Remember, botox targets muscles not wrinkles, and some muscles support our anatomy, and a lack of understanding of the dynamics between muscle groups can result in sagging, when inexperienced injectors try to tackle the wrinkle without knowing the effect. 

Your only option is to wait it out, and seek someone with more experience and a more conservative approach in the future.

Best,

 

Dr. Malouf

Botox may relax the lower eyelids and make them look more baggy.  In your photos the lighting is not the same.  The light is straight on in the before photo and coming from above in the after photos.  This accents the appearance of the bags.  You may even benefit from a lower eyelid blepharoplasty with fat pad removal. 

Dear RaeCat in Australia, Botox relaxes the muscle that it is injected in. There is a muscle [orbicularis oculi], that surrounds the eye & causes " crow's feet", through repeated contraction over the years. This same muscle also pumps fluids away from the eyelids area. When Botox is injected into the muscle, crow's feet lessen. However, as in ur case, some people notice extra puffiness , as a result of loss of the pumping action of the muscle, leading to fluid accumulation. This happens , even without Botox , after long sleep hours [when the muscle is not contracting] . Your problem will self resolve in a few weeks. NO NEED to worry. Just be sure to use LESS Botox next time! 

Injecting the lower eyelid is risky. Very little botox should be used to avoid loss of function of the lower lid constrictor. It probably take longer than 7-10 days sorry