Under Eye Still Puffy 9 Months After Botox

The botox injecitons will wear off after 4-5 months maximum. If tear troughs are injected with fillers, such as the hyaluronic acids, Juvederm or Restylane, puffiness can be seen for more than a year.

Hi Michelle.  While it is possible to have the side effect you are speaking about, it's very unlikely that any bags under the eyes that exist 9 months after your treatment are related to the Botox.  This is because the Botox has worn off after 3-4 months.

We would suggest checking with yourpractitioner to see the "before" pictures.  This should shed some light on your situation.  Good luck.

As Botox only lasts for 3-4 months, it has worn off so something else is to blame.  I would suggest going back to see the physician who injected you.  In the mean time, learn more about Botox in the link below.

My colleagues are correct. Botulinum toxin can rarely change the appearance of the lower eyelid (drooping or malposition) but it does not cause bags. Botulinum toxin does not permanently relax facial muscles. Rather, it weakens these muscles for a period of about three months. If you were only treated with botulinum toxin it is highly unlikely that this medication is to blame for the "bag" under your eye. You would possibly benefit from a lower eyelid blepharoplasty to remedy this.Stephen Weber MD, FACS

Michelle

Ouch, 9 docs disagreeing with you.  But they are right.  This is why we take before and after photos.  There is no debate that you may have bags under the eyes but these are normal for someone who is 40 years old.  So now that we have cleared up that misconception, the next question is what are you going to do about your lower eyelid bags?  

My recommendation, lets not throw the baby out with the bath water.  Surgery should not be your first choice.  I would first explore the use of fillers in the under eye area.  This can be amazingly effective for the lower eyelid bags for someone your age.  Also don't give up on BOTOX, it is very helpful along the eyebrow using the patented Microdroplet brow lift method. 

Without before and after pictures, it is very difficult to give you specific advice are draw any association between the Botox and your phenomenon.  The good news is that Botox is ALWAYS temporary and usually is gone within 3 to 4 months or at most 6 months.  Sometimes, and I am not saying that this is what happened with you, patients look at their faces more critically after having plastic surgery and start noticing things that were already there but never caught their attention.  My advice at this point is to contact your original injector and have them examine you and give you suggestions.

 

DMS

While it is possible that relaxation of the muscles adjacent to the eye with Botox could reveal an area of fat protrusion, the effect would be temporary. The Botox itself is rapidly cleared so it wouldn't cause long-term swelling.

Are you certain you had Botox? Botox and Dysport are delivered in a small amount of water. The swelling from the injection resolves in a few days. Both cause temporary paralysis of the muscles, and it is this that decreases the folding of the skin. While the glabellar frown lines can often be eliminated, laugh lines are reduced about 50% for most people. The cheek muscles will still pull the skin upward towards the eye causing some persistent wrinkling in the crow's feet area.

Fillers like Restylane and Juvederm are also used around the eyes. They do not stop motion, but do fill lines.  If over injected these can cause bags or lumps that can last for months. 

Injectables like Botox and Restylane seem very simple to use, and they require very little equipment and overhead. As a result, their use has spread far beyond the doctor's office. The best injectors are not often the cheapest, and unfortunately, after there are problems, people are more likely to check credentials. 

I would recommend following up with your injector. What you are describing does not seem possible with a single Botox injection, but you cannot be properly evaluated via the Internet. For your safety, find a qualified professional in your area, and make certain you do not have some other unrelated problem developing.

Michelle,

Sorry to hear of your problem, but you are not the only one who has experienced this.  Botox relaxes the orbicularis muscle when we treat crowsfeet.  If the injections are carried down under the eye it can improve the lines, but may lead to "bags".  The muscle can help support the fat behind the lower eyelid, so weakeness can temporarily allow the fat to "protrude". However, weakening the muscle can lead to less efficient clearence of the fluid collection around the eyes - basically decreased lymph drainage.  This can result in fluid pooling in fastoons below the orbital rim.  Once these form, they can be difficult to treat and may persist after normal muscle function returns.  It would be helpful to see your doctor again to see if you are dealing with fat protrusion or fastoons.  The treatments are different, so diagnosis is key.  I agree with the other experts in that the Botox at 9 months is gone  Good luck.

At 9 months the botox should have worn off.  Also, any swelling that occurred immediately after injection would have resolved over a few days.  I'm not sure why you still have some bags.  I'd recommend you see a plastic surgeon you trust and have them see you in consultation to see what can be done to help you.

Dr. Cat Begovic M.D.