Does Botox in the Frown Lines Cause Large Drooping Bags Under Eyes?

Hi There! I recently got Botox for the first time injected into my frown lines, 3 injections, 2 on each side of my eyebrow and one in the middle.

I had never had a problem with bags under my eyes until I got the Botox done, which leads me to believe that it may have somehow caused it? I don’t like my frown lines, but I dislike these bags even more!

Doctor Answers 8

Botox in the frown lines and droopy eyelids and bags under eyes

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There are a few possibilities for what might have happened to you.

1. Injections to the muscles underlying the crows feet (smile lines around the eyes) can cause the underlying fat of the lower eyelids to bulge - usually with individuals who have a loose underlying orbicularis oculi muscle and lax tissue to begin with.

2. If your injections were done relatively recently and deep in the glabellar complex (between the eyebrows) for the frown lines, if your doctor re-constituted the Botox with a lot of fluid, gravity can take that fluid to the lower eyelids to cause swelling in which case it should resolve with time.

3. The fluid introduced with injections to the crows feet can also travel to the lower eyelids to cause edema/swelling.

4. Unlikely I know, but the bags could be unrelated to Botox (?allergic/contact dermatitis).

I would consult the doctor who performed your injections for a face-to-face evaluation.

Good luck.

San Diego Dermatologist

These shouldn't be related

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The only way I can think these are related is if your treatment was very recent and what you are seeing is just some swelling.  There isn't any anatomical way I can think of where properly done injections in the brow could cause lower eyelid fat bags to appear.

Can Botox for the frown lines cause eye bags?

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Hi Bellaboo.  It's very unlikely that an injection procedure to the glabella (area between eyes) caused you to develop bags under the eyes.  Although Botox can migrate (move) outward from the injection site, it would be very unusual for it to migrate from the eyebrows to the under eye area.  If your injector took before and after pictures, we would suggest going back to address your concerns and look at your before photos.

Harold J. Kaplan, MD
Los Angeles Facial Plastic Surgeon
4.4 out of 5 stars 7 reviews

Botox lower eyelid bulges, an over-simplified explanation

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Occasionally the Botox can migrate to the lower eyelids and cause or make bulging eyelids more prominent.

Let me give you an analogy. Sucking in you belly can improve the appearance. IF you relax your stomach muscles, it may appear that your stomach is improved and thinner.

Same goes with the lower eyelids. The lower eyelid muscle acts like the stomach muscle to contain and hold back the fat around the globe (eyeball). IF you squint your eyes, this muscle tightens and pushes back the fat and makes your lower eyeid seem tighter and less bulging (like sucking in your stomach muscles). If these muscles relax, the lower eyelid may appear to bulge more.

If Botox has spread down to the lower eyelid, it can create this appearance.

I know this is a little oversimplified but it helps to explain.

Otto Joseph Placik, MD
Chicago Plastic Surgeon
4.9 out of 5 stars 86 reviews

First let's get the terminology right.

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Dear Bellaboo

To avoid confusion, it is important that we all agree on which lines we are talking about. A frown is the appearance of disapproval produced by furrowing one's brows. Generally frown lines are the lines that are developed between the eyebrows when we furrow. These lines are referred to at the "11" in some marketing material. So if you did receive treatment in the "frown lines" it would be understood to mean that you received BOTOX between the eyebrows to treat the worry lines. As such, this location of BOTOX treatment is not expected to produce any change whatsoever in the lower eyelids.

However, the area on the side of the eyebrows is generally referred to as the crowsfeet area. Alternatively this area may be referred to as the smile line area because when we smile this is where the lines heap up. When you are treated in these areas, it is possible for BOTOX to drift lower and effect the muscle that help firm the contour of the lower eyelid and this can result in the very ugly heaping you are describing in the lower eyelid. This may take some time to wear off.

In truth your doctor's technique is not ideal. By only injecting you in three locations, a relatively large volume of BOTOX solution has to be injected into each location. While this is great for the doctor because it literally only takes seconds to perform such a treatment, this method leaves the diffusion of the medication to chance and can cause very unpleasant surprises. Compare this to my microdropletTM BOTOX method ( This method precisely places microdroplets of BOTOX to control the treatment effect. However, this is a very time consuming approach but the control afford and the results make it worth the effort.

Kenneth D. Steinsapir, MD
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

Not related

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 Botox injection around the eye and under the eye may cause some laxity of the muscle and more fat pocket showing. Your botox injection was for the frown line and will not effect fat pockets. 

Kamran Khoobehi, MD
New Orleans Plastic Surgeon
4.7 out of 5 stars 153 reviews

Answers to both questions

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The amount of Botox that was injected probably wasn't that much. So there are two likely things going on. First, even a small amount of Botox can relax the muscle around the eye enough to make lower lid bulging slightly more pronounced. Second, the bulging was probably already present but you may have been more focused on the wrinkles.

As for what to do about it, a lower lid blepharoplasty with muscle plication and either a small amount of fat removal or fat redraping should resolve the problem.

Botox in the brow not related to lower lid bags

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Botox injections in the brow is not likely related to lower eyelid bags. What is more likely is that now that your eyebrow furrows are gone, you're noticing other areas around your eyes that could use improvement.

Do you happen to have any photos taken before your Botox treatment?

Jonathan Hoenig, MD
Beverly Hills Oculoplastic Surgeon

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.