Botox caused hollows under eyes. Can it be fixed? (Photo)

I have had botox for many years. I went to a new injector and asked for minimal botox in my crow's feet. She injected 9 units into each side. I now have hollows under the eyes and still have lines at the sides of my eyes. Is this fixable with more botox. I'd asked to be left with expression but maybe more botox to the sides would restrict movement and make the hollows less noticeable? They can only be seen when I smile.

Doctor Answers 5

Hollowing under eyes after Botox

Thank you for your question thaibutterfly. I am sorry to hear about your situation. Botox is a purified used to address wrinkles associated with facial expression such as  the crow's feet seen around the eyes when one smiles. Botox will relax the muscle and smoothen out the overlying wrinkles. In some people who have lost volume under the eyes, the muscle treated when Botox is used for the crow's feet (orbicularis oculi) holds up the fat pad in the upper cheek. When relaxed the fat pad is no longer held up and hollows can be seen. Hollowing under the eyes can be treated with fillers such as Restylane. Most people enjoy the results of their Botox treatment for 3-4 months. At this time the skin is usually back to baseline. Please consult with a doctor for specific recommendations. Good luck!

Encino Physician
5.0 out of 5 stars 1 review

Botox and under eye hollows

The photograph you have taken does not allow anyone to fairly evaluate the effects or ill-effects of the botox treatment.  Botox as a neurotoxin can weaken lower lid musculature is injected in the area too close to the margin of the lower eyelid, and this may inadvertently lead to variations in muscular activity and hence differences which are then interpreted as hollows.  

It is best to wait out the period of botox efficacy (4 months) and then reassess the entire facial/periocular area for rejuvenation.  One of the detrimental effects of chronic toxin treatments are subtle changes in facial features over time.  This is why a conservative approach to the use of neurotoxins and fillers in facial rejuvenation is a more prudent course rather than to prescriptively return for follow ups at 4 monthly intervals for years on end.


Chetan Patel, MD
South Africa Plastic Surgeon
5.0 out of 5 stars 3 reviews

Botox caused hollows under eyes. Can it be fixed? - No and Yes #fb #botox #hollowundertheeyes #drmesa

Botox is a cosmetic treatment to improve facial lines and wrinkles secondary to contraction the facial muscles. Therefore, Botox is usually done to treat labella lines ( 11's) , forehead lines ( horizontal lines) and crow's feet lines ( radial lines that appear start from the outer corner of the eye). Botox, like any other cosmetic treatment is associated with risk and complications. However, Botox has not been shown to cause "hollowing" under the eyes.

Patients may complain of "hollowness underneath the eyes caused by Botox". Since Botox does not cause eye hollowness, it is very likely this physical finding was present long time be fore the Botox injection. However, due to the crow's feet lines, this could have been "masked" by the wrinkles. Very often, patients after Botox treatment start to realize other aesthetically unpleasant physical findings of the face once the full effect of botox is in place ( like hollowness under the eyes). This is because the wrinkle free Botox treatment area no longer "catches the eye's attention". Before and after pictures in my practice are an excellent way to demonstrate the above statement on my practice.

Hollowing under the eyes could be improved either surgically or with filler treatment. 

John Mesa, MD
New York Plastic Surgeon
5.0 out of 5 stars 97 reviews

Botox Caused Under Eye Hollows

Unfortunately, you will need to wait to allow this to wear off.  If you opt to have more Botox, it should be placed further away from the eyes, over the "crow's feet".  This would help to diminish the wrinkles, but will not reduce the hollowing.

Botox crows feet

Thank you for your question.  This looks like a technique error, I would return to your physician and discuss with her your results so that she may correct it with additional Botox targeting the areas that concern you.  Regards, Dr. Matt Elias

Matthew Elias, DO, FAAD
Fort Lauderdale Dermatologic Surgeon
5.0 out of 5 stars 5 reviews

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.