Botox for Undereye Bags?

The typical bags under eyelids are caused by swelling of fluid or herniated fat pads so that there would not be an expected improvement with Botox injections.  Some patients do, however, have an enlargement of the muscle tissue of the lower eyelid and this hypertrophic orbicularis oculi muscle may thin down after Botox injections diminish the muscular contraction. This should only be done by a well-experienced Botox physician injector.

Botox is not intended to treat under eye bags.  Botox is a injectable that is used to temporarily treat wrinkles around the eyes, forehead, and glabella.  The best option for bags under the eyes is a procedure called lower Blepharoplasty.  It removes the excess fat under the eyes therefore reducing under eye puffiness.  Consult your board certified plastic surgeon to be evaluated for the best treatment for you. 

Dear lad68,
I like to think of Botox as something that is used for dynamic lines or lines that are obvious when you are moving a particular muscle on the face. On the other hand, fillers (such as Restylane, Juvederm, fat, etc.) are used on static lines/folds or lines that are present even when you are not moving parts of your face.

Around the eyes, Botox is usually only used to reduce the appearance of “Crow’s Feet” which are the lines of movement that you see by the side of your eyes when you smile. Botox would not help reduce the appearance of bags.

A filler, such as Restylane or fat, may be placed along the area where there may be under-eye hollows or dark circles. However, you should go to a highly experienced injector when getting this area filled because this is an area that is not forgiving of improperly placed filler.

Bags under the eye are often caused by fat protrusion and if this is truly the case with you, then the only option would be surgery to reposition or remove the fat through a blepharoplasty procedure. Sometimes what a patient views as “bags” is really not a protrusion, and the surrounding area can be injected with filler to conceal the appearance of bags. Without photos, it is difficult to say which one is your issue. I would recommend you have a consultation with someone who has experience with fillers and surgery, so that he/she can guide you appropriately.

Dr.Sunder
 

Bags under in the lower eyelids are usually caused by small bulges of fat and loss of fat just below that at the orbital rim.   Hyaluronic acid fillers like Restylane, Juvederm or microfat transfer using your own body fat can be used to fill in the areas around the bags to improve this area and eliminate a tired look.   Botox is used for wrinkles that are caused by facial expression e.g. crow's feet, lipstick lines, frown lines or elevens, forehead lines.

Hi

generally, bags of the eyelids cannot be treated with botox because it will loosen the skin and potentially exacerbate the puffiness as the muscle will have less stregth in pushing the orbital fat backwards. It sounds like botox isnt the appropriate intervention for this issue. COnsider seeking the advice of an ASOPRS-credited oculopplastic surgeon.

Botox works by weakening muscles of expression to soften dynamic wrinkles. For under eye bags or hollows, this is not helpful. Some physicians are trying to use fillers to camouflage under eye bags, but this may have the effect of making the entire area look too puffy instead of what may instead need a gentle surgical correction. I advise careful research and a few consultations with dermatologists, plastic surgeons, and especially with oculoplastic surgeons, before making a treatment choice. This is a tricky area that can really have problems if there are mistakes.

Under eye bags are caused by thinning of the skin and connective tissue which leads to the protrusion of the fat beneath it. 

Botox is used to relax muscles in order to smooth wrinkles.  Muscles are responsible for horizontal creases immediately under the rim of the lower lid, and those can be relaxed.  However, there is no muscle involvement in the formation of under eye bags, therefore Botox would not work.

Hello and thank you for the question.

There is no indication for Botox Cosmetic in the management of under eye bags. Botox may be used for the management of dynamic rhytids under the eyes ( aka "Jelly Rolls"). Keep in mind that this is an off-label use of Botox Cosmetic and I would advise that you seek treatment by trained professionals with significant experience in this area. Under eye bags, in general, are attributed to pseudoherniation of orbital fat. Treatment for eye bags generally requires surgical management. I recommend you consult with a Board Ceritifed Plastic Surgeon for a proper evaluation.

Best,

Glenn Vallecillos, M.D., F.A.C.S.

Botox will not improve the bags you describe under your eye.  If indeed you have bags and extra skin below your eyes that make you look tired, you will likely need a lower eye lift also known as a lower blepharoplasty to definitively treat this problem.  As a non surgical option, fillers or fat grafting may be another option.  Please visit with a board certified plastic surgeon to explore ALL your options.

Best of luck.

Dr. Basu

Botox temporarilly weakens muscles, so it helps improve wrinkles that come and go when muscles contract, like frown lines, forehead lines, and crows feet. Fillers like Radiesse, Juvederm, and Sculptra fill hollow areas of the face and fill deflated areas, so they are used for different aspects of aging. Lower eyelid bags can sometimes be camouflaged with fillers, or treated by surgery.