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I Had Undereye Botox 5 Months Ago and Still Have Have Horrendous Fat Pouches Under my Eyes.

I have returned to the cosmetic surgeon twice and he said that it would go in time. I look like I have two black eyes, minus the bruising! I went to two other surgeons and one said wait it out and the other questioned whether filler had been used instead of Botox! I am devastated. I have an appointment with a dermotogist this week to see if Laser might work. At the moment I don't feel like this is ever going to go away. Should I steer clear of Botox forever?

Doctor Answers (17)

Increased Lower Lid Bags after Botox

+2

Regarding: "I Had Undereye Botox 5 Months Ago and Still Have Have Horrendous Fat Pouches Under my Eyes.
I have returned to the cosmetic surgeon twice and he said that it would go in time. I look like I have two black eyes, minus the bruising! I went to two other surgeons and one said wait it out and the other questioned whether filler had been used instead of Botox! I am devastated. I have an appointment with a dermotogist this week to see if Laser might work. At the moment I don't feel like this is ever going to go away. Should I steer clear of Botox forever
?

I am assuming the ?doctor who injected you indeed used Botox and not a filler. Although WHY would any Plastic surgeon or Dermatologist who has even a basic understanding of botox inject it in the lower lid ("under the eye") makes no sense.

Botox weakens / relaxes muscles. Since the thin muscle around the eye, the orbicularis oculi muscle, barely keeps the fat around the eye within the eye socket, it makes NO sense to weaken it in a foolish attempt of smoothing wrinkles of the central lower lid. Doing so will almost always result in intraorbital fat pooching out causing worsening bagginess of the lower lids and a much more aged look.

 I would not steer away from Botox forever but I think you should steer away from inexperienced Botox injectors forever and a day.

Dr. Peter Aldea


Memphis Plastic Surgeon
5.0 out of 5 stars 63 reviews

Botox undereyes

+2

Botox will not do anything for the under eye bags.  Fillers can sometimes camouflage them. If they are swollen from edema( water) , perhaps you had a filler placed?

Steven Wallach, MD
Manhattan Plastic Surgeon
4.5 out of 5 stars 17 reviews

:Lower eyelid fat pad pouches, bulges or bags and Botulinum Toxin (Botox and Dysport) injection

+1

Botulinum Toxin (Botox and Dysport) injections can make EXISTING lower eyelid fat bags or pouches appear to be worse but it is not known to make them appear de novo. The lower eyelid muscle tends to hold the fat back around your eye the same way your abdominal muscles hold back your intra-abdominal fat. And in the same way you can make stomach bulge by relaxing your stomach muscles, your lower eyelid fat can bulge out when the muscle relaxes. Tho opposite occurs when you squint - it tightens your eyelid muscle and pushes back the fat pads.   

Otto Joseph Placik, MD
Chicago Plastic Surgeon
5.0 out of 5 stars 48 reviews

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Botox - fat under the eyes

+1

In general, I'd recommend placing botox in the crows feet area only.  Other areas around the eye like under the eye can cause some problems.  It's impossible to recommend what treatment would be best for your eye area without seeing you in person.  In general I'd recommend going to a board certified plastic surgeon, facial plastic surgeon, or oculoplastic surgeon experienced in the eye are to give you the safest and most accurate advice.

Dr. Cat Begovic M.D.

Catherine Huang-Begovic, MD
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Discuss Botox with the dermatologist

+1

The fat bags you complain about are probably not from your Botox injection, since it would all be worn off by 5 months. You definitely need another opinion about what had happened and hopefully the dermatologist you see can help. It may also be helpful to the dermatologist for you to get a copy of your records from the doctor who initially treated you.

Theda C. Kontis, MD
Baltimore Facial Plastic Surgeon
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Fat bags after Botox

+1

If you had Botox to treat the fat bags, you had the wrong procedure.  Botox only relaxes the muscles.  Sometimes it helps with under eye muscles that are prominent but it never helps the fat bags.  Filler may be able camouflage the bags.  Removal of the bags with a lower lid blepharoplasty is likely indicated unless your anatomy makes this type of surgery too risky.  You should be evaluated by a plastic surgeon, not a dermatologist.

Lisa L. Sowder, MD
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Botox and lower lid fat herniation

+1

It is actually quite common in older patients wanting to get rid of the lines under the eye and the doctor injected too medial into the muscle around eyes. The protruding of the fat does not go away after BOTOX wears off especially if you are older. You option now would be lower eyelid surgery to remove the fat pocket. Laser may help temporarily but you will be much better off with lower lid surgery.

Norman Ge, MD
Orange County Facial Plastic Surgeon

Fat pouches under the eyes after Botox

+1

Contrary to what some responders are saying, it is possible that injection of Botox under the eyes can lead to what is called pseudo fat herniation. That is , the muscles that hold in the SOOF fat pads are relaxed by the midpupillary injection of Botox.  I do agree that this should have been more temporary however. If they used Dysport instead of Botox it may last longer so giving it more time is wise.  The key is that it should not be permanent. An oculoplastic surgeon is the ideal persion to meet with to discuss your concerns if surgery is indicated.  Be sure that they are board certified and fellowship trained in oculoplastic surgery. Lastly, ask your doctor if they used Botox and filler.  If they did use filler the solution is even more simple with an injection of hyaluronidase. Again, see the cosmetic dermatologist first and they can get the info from your doctor that is necessary to proceed. Print out the real self responses and take them to the derm to see what they think when they actually see you in person. This will give you your best chance at resolving the issue 

Shawn Allen, MD
Boulder Dermatologist
5.0 out of 5 stars 1 review

It is unlikely that fat pad bulging 5 months after botox is due to the botox.

+1

botox wears off in 3-4 months and doesn't cause fat pad bulging in the first place.  Is it possible that you had a filler placed under your eyes?  Wishing you the best.

David Hansen, MD
Beverly Hills Dermatologic Surgeon
5.0 out of 5 stars 26 reviews

Fluid of lower eyelids after Botox

+1

If Botox were the only thing injected in the lower eyelids, and if you had a tendency to retain fluid in your lower eyelid bags, then the Botox might interfer with the muscular pumping action of the eyelid and the fluid could accumulate more. In general, though, the Botox effect would not last more than five, to six months tops and the fluid situation would be expected to improve. Was there more than one needle prick youfelt in each lower eyelid? Possibly a filler was injected. Ask your doctor who had performed the treatment.

Ronald Shelton, MD
Manhattan Dermatologist
5.0 out of 5 stars 31 reviews

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