Outer eyes area looking hollow. Also a little swollen on upper cheeks (Photo)

Outer areas of my eyes look hollow, also the upper cheeks seem a little swollen? Not concerned about tear through, just outer eye areas. I'm a Botox patient, my doctor told me this is not related to Botox at all, but looks like SOOF Edema. I don't know what this is, or how to treat. Picture was taken >6 mo after botox treatment. I wanted to see if it wears off. Might this be caused by botox or is it just natural aging?

Doctor Answers 5

Hollow under eyes

I don't think this is botox related. You do have some relative hollowness around eyes and relative fullness of cheeks. You might benefit from strategic placement of filler to make the area more smooth with natural appearance.

Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 58 reviews

Edema upper cheek is malar fat pad "festoons"

The swelling is related to development of malar festoons. This is a difficult problem to fix and is unrelated to Botox. Hollowing in the lateral orbital area is correctable with fillers. I prefer Restylane and blunt cannulas for this area. It is safer and less bruising is noted. The undereye/tear trough area can be corrected at the same time.

Steven F. Weiner, MD
Panama City Facial Plastic Surgeon
4.6 out of 5 stars 26 reviews

Hollowing under eyes

After six months, any Botox effect will have worn off. You could consider having filler placed in the tear trough area under your eyes to fill in hollows.  I prefer to inject this area gently with a cannula instead of a sharp needle.  


Dr. Ort

Richard Ort, MD
Lone Tree Dermatologic Surgeon
5.0 out of 5 stars 22 reviews

Botox results

At this point 6 months after your Botox injection, the effects of the Botox have worn off and the swelling is probably unrelated. Actually, the photo itself does not really demonstrate much swelling. You do have a descent amount of undereye hollowing which could be corrected with placement of a filler such as Belotero or Restylane.

Outer Eye Hollows / Dark Circles / Eye Wrinkle - Lasers (Fraxel, Co2/Erbium, VIVA/Intensif); Microneedling/PRP, Fillers/Belotero

After 6 months, Botox will have worn off. In treating eye hollows, a combination approach is best. I use a combination of lasers, microneedling/PRP, fillers and skin care/peels which can improve this area. See an expert. Best, Dr. Emer

Jason Emer, MD
Los Angeles Dermatologic Surgeon
4.9 out of 5 stars 159 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.