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

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.

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