Fat pouch has developed in upper inner corner of eyes, cosmetic surgery needed or sign of medical issue? (Photos)

Question

Hi, I'm a 42 y.o woman who works on screen and in fashion. I've had Botox 6 times over 10 years just on my forehead in btwn eyes. I have not had Btx in 1 year. Over that time I've developed a fat pouch. It's worse in the morning. No amount of cold Presses make it go away. Is this something I need sugerically removed or is it a sign of a medical issue? It's only happening on the inner corner and not the whole eye lid. Is that normal? No one else in my family has this. What are my options?

Paul E. Goco, MD · Answer

Thanks for your question and photos.  The area you are describing is a very common fat pocket associated with aging.  It is not related to botox injections.  The area may appear more prominent in the mornings due to swelling from water retention, excess salt intake, allergies.  This usually needs to be removed surgically.  Please seek out a surgeon experienced in eyelid surgery.  Good luck!

Philip S. Schoenfeld, MD, FACS · Answer

Thank you for the photos.  I think that it is probably wise to have routine blood work to make certain there are no other associated issues.  Thyroid function tests would be appropriate at your age and may yield some information.  In general, you appear to be experiencing fat herniation of the medial and middle fat compartments of the upper eyelid.  A blepharoplasty procedure will address the excess skin and the fat herniation at the same time.

Tanveer Janjua, MD · Answer

The whole are appears to be a little swollen. I would recommend you see an endocrinologist to make sure you do not have a thyroid issue. Once that is cleared then see an eye doctor to rule out any eye condition. After that you would be a candidate for upper eyelid blepharoplasty to reduce the extra fat and skin.RegardsDr. J

Yannis Alexandrides, MD, FACS · Answer

As it's been a year since your last Botox treatment, it will not be the Botox that is causing this effect at the moment, as the Botox wears off over the course of 3-6 months. The substance will have completely dissipated and dissolved by now. It is true that Botox can cause a hooded appearance, as the muscle holding up the brows is no longer able to do so. However, in your case I believe this is due to natural ageing...you could try compensatory Botox which is injected in different areas to elevate the eyebrows and give a slight lift. Another option would be an upper Blepharoplasty to remove the excess skin on the upper eyelid or a brow lift.

Lillian Overman, MD · Answer

Hello,
It is always important to consider medical causes of problems that appear to be cosmetic. Fat pads over the eye seem to occur in families and not be confined to the inner corner. Most importantly, it is worse in the AM, suggests that it might be caused by edema (fluid) and not fat. One cause of edema around the eyes is hypothyroidism (low thyroid function), but there are other conditions that can cause it too. I suggest the you schedule an appointment with your primary care physician.
Let us know how you do with this.
Best regards,
Lillian Overman, MD

Mitesh Kapadia, MD, PhD · Answer

It looks like you have excess fatty tissue present in the inner corners of your upper eyelids. The fat can be removed surgically through a small incision along the inner aspect of your eyelid creases. This can easily be done in the office setting with local anesthesia only or under sedation if you feel more comfortable that way. Fat in this area is unrelated to Botox. Thyroid conditions can sometimes cause eyelid fatty deposits to worsen, but most of the time the fat is just due to the aging process.

Sean Doherty, MD, FACS · Answer

Botox is not the cause of your "fat pouch". This is simply a sign of aging. Very common. Sadly, the only fit is surgical. Schedule a consultation with a board certified plastic surgeon or oculoplastic surgeon to be assessed in person and discuss.

Steven F. Weiner, MD · Answer

This is unrelated to Botox and is a natural fat deposit. It has enlarged or sagged with aging. This can be removed only with surgery. I suggest an Oculoplastic Surgeon, Facial Plastic Surgeon for this procedure.

Paul Pietro, MD · Answer

Hello CTlady75,Thank you for sharing your question and photos with us. Seeing as how you have not had Botox in one year and your exposure prior to that was minimal (6 times over 10 years) what you are seeing is not related to Botox. This has long since worn off. This does however appear to be part of the normal aging process relating to the fat pads of the eyes. See a plastic surgeon/oculoplastic surgeon and discuss your surgical options of which would be done in the office setting under local anesthesia. Be well.

Daniel Zeichner, MD · Answer

Hi and welcome to our forum.
From the photos, you demonstrate significant fullness of the medial upper lids. 
If the fullness changes during the day (worse in the am, better when up and around), this could represent swelling due to a medical condition.
If, however, the fullness is constant, a blepharoplasty can eliminate the fullness.
I recommend evaluation by a board certified plastic surgeon.
Best wishes!

Fat pouch has developed in upper inner corner of eyes, cosmetic surgery needed or sign of medical issue? (Photos)

Answers (14)

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