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

It can take up to 6 months for Botox results to fully go away. I would wait another 2 months before considering any other treatments.

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!

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.

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

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.

Thank you for your honest and detailed question. I understand how distressing changes to the under-eye area can feel, especially when they linger for months.

What Likely Happened:
Botox under the eyes is an off-label use and must be approached with extreme caution. Injecting too much or placing it improperly can weaken the orbicularis oculi muscle, the muscle that supports the lower eyelid. This weakening may lead to:

Worsened puffiness or bags

Loss of muscle tone under the eye

Prolapsed fat pads becoming more visible

Since you're now 4.5 months out, the majority of the Botox has likely worn off — but muscle tone can take time to rebound, and changes to tissue structure can persist.

Non-Surgical Options You Can Explore:
1. Radiofrequency Microneedling
Unlike EmFace (which uses RF and HIFES), radiofrequency microneedling (e.g., Morpheus8, Secret RF) can tighten the under-eye skin, improve texture, and stimulate collagen more deeply. It may give better results for persistent laxity.

2. PRF (Platelet-Rich Fibrin) or PRP Injections
These natural treatments use your body’s own platelets to stimulate tissue healing, improve skin quality, and reduce the appearance of hollowing or puffiness. A good option if you’re filler-averse.

3. Polynucleotide or Exosome Therapy
Emerging biologic treatments like polynucleotides (e.g., Plinest, Nucleofill) or exosome serums/injections can improve dermal density and reduce inflammation without volume changes.

4. Gentle Topical Retinoids + Caffeine-Based Eye Creams
While results are modest, they can help with skin firming and fluid drainage over time, supporting deeper treatments.

Additional Notes:
Avoid further Botox under the eyes in the future unless administered in extremely low doses by a provider with specific expertise in this delicate area.

You’re not out of options—it’s just about finding the right approach for your anatomy and preferences.

Filler is not always the best solution for under-eye bags, especially when the issue is caused by muscle weakening or fat pad prominence.

There is hope, and you’re not alone in experiencing this type of side effect. With patience and the right treatments, many patients see significant improvement without needing to go straight to surgery.

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.

As a general rule, Botox should almost never be injected into the lower eyelid as it invariably results in the formation of the eyelid bags. This happens because the muscles are very weak to hold the fat in place. No procedure even Surgical ones will help you. You simply need to be patient until that week muscle comes back into action and that may take six months up to a year. Remember the surgery will not help. I hope this helps and good luck from Leonard Grossman, MD, organic Plastic Surgery New York City.

Based on the poorly one posted photo at too far distance, it appears you have some lower eyelid, excess fat, and laxity of skin on the very small or limited side of the evaluation scale. I would use in my practice. The Endo lays treatment one or two sessions under local anesthesia each session $1200 if that treatment does not improve or give a satisfactory result then only a surgical lower lid left plasty with removal of fat pad option is available. Best a virtual concert with or repost better photos for a more accurate evaluation but better virtual consult with regards.