Why is puffiness under my eyes getting worse after Botox injections 3 months ago?

Thanks for your question and as you know, Botox lasts approximately 3-4 months in most people so if there is a Botox effect, this will improve over the next month and revert back to your baseline soon.  If not, then I would return to your provider and see what is going on by having an appropriate physical exam.  But I do think this will resolve soon.

It is unusual to have the problem continuing to get worse. I expect that it will get better soon. The problem that cause this is that there is too much Botox given and the pumping mechanism of the lower eyelid has been lost. Lymphatic drainage is now impaired. If the lower eyelid is lax, Botox shouldn't be injected. A "bow string" test is normally used to see if the lower lid has enough tension for an injection.