Botox caused under eye bags. Emface treatments are not helping. Can I improve this without surgery? (Photo)

Question

So I had under eye botox 11 units under each eye. Results were terrible bags under each now. 4 and a half months later I'm still left with them. I'm Doing EmFace treatments which cost a lot but am not seeing results. Filler scares me. Surgery is expensive. What are my options I can't live another day looking like this is their any hope or is surgery my only option?

Anil R. Shah, MD · Answer

Hello! My name is Jessica, I am a physician assistant, and one of the providers at Aesthetic Skin - Winnetka & Chicago. This is a great question. It’s completely understandable to feel overwhelmed after a treatment didn’t go as expected, especially in such a delicate area like under the eyes. Botox under the eyes can sometimes weaken the muscles that support the lower eyelid, which can lead to or worsen the appearance of under-eye bags, especially if the muscle tone was already borderline. At 4.5 months out, most of the Botox should be wearing off, and hopefully some of the drooping or puffiness will continue to improve gradually. EmFace is more geared toward lifting and toning facial muscles, but it typically doesn’t address fat pad herniation or laxity directly under the eyes—so if bags are your main issue, it might not be the ideal tool, especially for the cost. While filler can be risky in this area, precise under-eye treatments using cannulas or diluted HA to smooth transitions—though this isn’t a fix for true bags, just for hollowing. Laser resurfacing (such as fractional CO2) may help improve skin texture and tightness if the issue is mild laxity, and radiofrequency microneedling (like Morpheus8) may offer some improvement too. But if the bags are caused by fat herniation (which sounds likely), surgery—specifically lower blepharoplasty—is unfortunately the most definitive solution. It's an investment, but many patients see long-term, natural-looking results. I hope this helps and best of luck!

Camille Cash, MD · Answer

Botox results are temporary, generally lasting three to four months but can be longer for some patients.  You should be noticing improvement.  You may try Morpheus8 for improvement.  This treatment combines RF technology and microneedling to improve overall skin tone and texture.  I've included a video I hope you find helpful.

Tanya T. Khan, MD · Answer

Hello, what you are describing is sometimes a common result of injecting botox under the eyes (which is very rarely done for a very specific type of patient who has a strong orbicularis muscle tone when smiling). Basically the muscle tone is reduced and the bags become even more prominent than before. I would advise waiting for the botox to completely wear off and reassess the lower lids at baseline. PLEASE make sure to visit an experienced oculoplastic surgeon to properly assess your eyelids and provide treatment recommendations. Treatment may range from skincare / skin tightening by device or peel / filler / surgery.

Anna Petropoulos, MD, FRCS · Answer

Hello Nice768997,

There are many non-surgical options available to treat under-eye skin laxity. In our office, our go-to treatments are Morpheus8, SylfirmX, and Scarlet RF—all of which use radiofrequency microneedling (RFMN) technology. These treatments stimulate new skin cell production, boost collagen regeneration, and firm existing collagen for smoother, tighter skin.

Each session involves minimal downtime—typically 12 to 48 hours. You may experience redness and puffiness, which often resolve within a few hours. The next morning, the treated area may appear blotchy or slightly swollen, but this typically improves throughout the day.

For best results, we recommend a series of 3 treatments spaced 4–6 weeks apart, followed by annual maintenance sessions.

Radiofrequency energy can also help tighten dilated lymphatic channels, reducing fluid retention and tightening loose skin—without melting the natural fat pads that provide volume under the eyes.

As always, it's important to choose a provider with the proper experience and professional training. Being in skilled, knowledgeable hands is key to achieving safe, effective results!
I hope this helps! Best of Luck! Jeanine Oteri, LME, LT answering on behalf of Anna Petropoulos, MD FRCS Center for Classic Beauty Boston & Danvers, MA

Nick Slenkovich, MD · Answer

Hello! I’m Lauren, the aesthetic injector here at Colorado Plastic Surgery Center.  Botox typically gets metabolized within 3 to 4 months, after which muscle movement gradually returns. For under-eye concerns, if we want to avoid filler or surgery, PRP injections are an option.  PRP (Platelet-Rich Plasma) injections use your own blood's growth factors to stimulate collagen production, improve skin texture, and reduce dark circles or fine lines. Results can vary, and multiple sessions are often recommended for optimal improvement.

Botox caused under eye bags. Emface treatments are not helping. Can I improve this without surgery? (Photo)

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Answer: Botox caused under eye bags.

Answer: Botox caused under eye bags.

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Botox caused under eye bags. Emface treatments are not helping. Can I improve this without surgery? (Photo)

Answers (8)

Answer: Botox caused under eye bags.

Answer: Botox caused under eye bags.

Answer: PRP under-eye injections

Answer: PRP under-eye injections

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Everything you need to know about Botox

Our mission is to create a world where every investment in modern beauty is Worth It.