Botox or Filler or both? Malar Bags (Photo)

Question

I’ve had slight malar bags for years successfully camouflaged with cheek filler for 2 years. I had top up filler Oct (same practitioner) then end of Nov I had Botox to crows feet and slightly under eye for the first time. Malar bags are now swollen. Reputable qualified physician who did the treatments has said to dissolve filler and refill. I’m concerned however that Botox has contributed to the problem and wondering would it be best to wait until this has worn off just incase?

David Hill, MD · Answer

If you had toxin to the lateral eye, undereye, or upper cheek, it could worsen the look by making the orbicularis oculi muscle (the one around the eye) weaker, allowing the fat pads of the undereye to bulge out more. If you didn't have any toxin to these areas it is unlikely that the toxin is worsening the look, and instead more likely that the filler you had is worsening the underlying malar edema, or possibly that it has migrated or become more superficial. I agree the answer is to dissolve and start over, but it is more likely that a lower blepharoplasty would be a better fix to resolve the malar bags, and possibly laser resurfacing of the undereye if there is any skin laxity or fine lines/texture there.

Camille Cash, MD · Answer

Malar bags are difficult to treat.  You may have some improvement with Morpheus8 treatments which can improve overall skin tone and texture.  Fillers can actually make malar bags appear worse.

Nuket Eroglu, MD · Answer

Hello,Firstly, if you want to dissolve the filler you had under your eyes, I want you to know that it may harm your own tissues as well. If there is no appearance that bothers you significantly, it would be healthier to consider dissolving as the last option. When dissolving hyaluronic acid fillers, an enzyme called "Hyaluronidase" is used, and this enzyme can also harm our tissues containing hyaluronic acid. Therefore, the dissolving process should be the last option.
Botox is not performed under the eyes. The reason for puffiness may be due to this. Botox is applied to the forehead, between the eyebrows, crow's feet lines beside the eyes, the tip of the nose, corners of the lips, and the masseter muscles, which are the chewing muscles. When Botox is applied under the eyes, it can create puffiness and disrupt the appearance of the eyes. Therefore, the source of your problem may be the application of Botox under the eyes. I recommend waiting at least four to six months.
Among the procedures to make the skin around the eyes tighter, smoother, and younger-looking, Thermage FLX and Ultherapy are at the forefront. I recommend getting Thermage FLX around the eyes. Afterward, if you have pigmentation, you can support the improvement of your appearance by using mesotherapy with lightening products to make the under-eye area even lighter. Remember, Botox and fillers should never be applied to tissues that have lost their elasticity. The priority for under-eye puffiness should always be to increase elasticity. I am confident that you will be very satisfied with Thermage FLX. I recommend it with confidence.

J. Renee Booth, MD · Answer

Botox (or any other botulinum neurotoxin) can allow puffiness under the eye to push forward. This is because the muscle (orbicularis oculi) which normally holds it back is now relaxed. When the neurotoxin wears off, it should improve. There is nothing wrong with allowing the Botox wear off. If filler is redone while the Botox is active, then less filler will likely be used, and the look of the under-eye area may change once the Botox does wear off.

Botox or Filler or both? Malar Bags (Photo)

Answers (4)

Answer: Botox under the eye

Answer: Botox under the eye

Recommended reading

Everything you need to know about Botox

Our mission is to create a world where every investment in modern beauty is Worth It.

Botox or Filler or both? Malar Bags (Photo)

Answers (4)

Answer: Botox under the eye

Answer: Botox under the eye

Browse related questions

Recommended reading

Everything you need to know about Botox

Our mission is to create a world where every investment in modern beauty is Worth It.