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

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.