Is my fat under eye bulge caused by Botox? (Photo)

Question

I've recently noticed a large eye bulge under my right eye, which I think might have been caused by botox in the crows feet area. I did not notice it prior and she did inject into that area. It's strange as I don't have it on the left eye at all, although I do have a eye crease and sleep on this side of the face which may worsen this. Is there any suggestions on cause and what I can do to get rid of it?

Brian S. Biesman, MD · Answer

While Botox injections can predispose to swelling under the eye in certain situations, Botox or other neuromodulators cannot affect the development of fat pads.  I strongly recommend seeing a specialist to is highly experienced in the administration of Botox and other neuromodulators as well as in lower eyelid surgery to determine your options.

Martin Jugenburg, MD · Answer

Thank you for your question. In some cases Botox can assist in the appearance of under eye puffiness. Once the Botox wears away your under eye should relax back to the original state. If you considering continued use of Botox, schedule an appointment with your injector to discuss treatment options to your under eye. Best,

Evan Ransom, MD, FACS · Answer

Thank you for the question and your photos. When Botox is placed at the crow's feet by the outside corner of the eye, part of the orbicularis muscle is made weaker. In some cases, this can lead to a little fluid buildup in the under eye area (edema), which is normally "squeezed out" by action of the muscle. Also, depending on the thickness of the muscle and the dose used, extra compensatory activity of the orbicularis muscle just under the eye can be seen. Either way, this will wear off over a few weeks after the treatment. Please check in with your Botox provider.

Stephen Prendiville, MD · Answer

The fat pockets under the eye are held in place by a structure known as the orbital septum.  The large circular muscle around your eye (orbuclaris oculi) which causes crows feet functions to close the eyes, mediate blinking etc.  Generally speaking, Botox is injected in doses that weaken this muscle but do not leave it completely paralyzed.  I would be surprised if Botox was the cause of this problem but would need pre treatment photos and an exam to provide further commentary.

Michael H. Gold, MD · Answer

Thanks for the question and including the photos as well. As noted by some of the other doctors here, the use of Botox in the crow’s feet can impact the fat pads under the eye, and in some instances cause what you are seeing now. In the photos, you do have a tear trough noted, and if needed, this can be treated with some filler, which might minimize what you are seeing under the eye now.  In time, however, this will go back to its baseline, when the toxin wears off.  We do recommend that these injections be given in offices of board certified dermatologists or plastic surgeons and that, in instances such as this, you return to your provider to see what happened and what can be done to correct the problem.

Steven F. Weiner, MD · Answer

The fat wasn't created by the Botox. It was already there. However your lower lid needs some tension in it to hold this in place. It is relaxed too much so the fat will prolapse more and be more visible. There is nothing that can be done now. The Botox will wear off and the problem will get better.  Future injections need to not be as low so as to leave tension in the lower aspect of the muscle.

Mats Hagstrom, MD (license on probation) · Answer

The muscle we treat to control crow's feet is called the orbicularis oculi muscle.It sits above three small pads of fat that surround the lower eyelid.Gentle tension of this muscle helps hold the fat pads in.In fact, if you look carefully in the mirror when you contract this muscle, you can watch the fat pads come in a little bit.This may be difficult on one side since it has been recently treated with Botox.It's important to stay lateral or out towards the side when treating crows feet.This is especially true for patients who have bulging lower eyelid fat pads or the beginning of them.This should, of course, get better as the Botox wears off.Next time, the Botox should not placed as far medialy or towards the nose.Best of luck,Mats Hagstrom, M.D.

Is my fat under eye bulge caused by Botox? (Photo)

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