Can years of under eye Botox create Malar Mounds? (Photo)

Hi KN,
The relatively high dose of Botox for your lower eyelids is preventing your muscles from contracting and squeezing accumulated fluid from your malar area.  This should resolve when the Botox wears off, avoid injecting this area in the future and look to other ways to treat what bothers you.  Good luck and be well. 
Dr. P

Thank you for your question and photographs.  Botox cosmetic will wear off completely in approximately 3-4 months.  Under eye puffiness that is more prevalent in the morning is likely fluid accumulation due to allergies or normal fluid shifts.  Best of luck.

This may be due to Botox placement. Botox results resolve in 3-4 months. Venus legacy and thermage treatments can soften results. Best, Dr. Emer

Hi,Thank you for including photographs. It is unusual to inject botox in the area you are describing especially at that dose. The wrinkles under the eyes are best treated with skin resurfacing. Weakening the muscle under the eye can potentially cause some sagging of the under eye skin and muscle BUT there are also lymphatic channels under the eyes that can become puffy (worse in AM, after drinking, high salt, etc). I recommend stopping the botox treatments in that area and maintaining a low salt diet and low alcohol consumption and watch for improvement. All the best,Mehdi Sina, MD

I have been injecting botox under the eyes for 30 years and the dose is not too high. If you are having the appearance of lower eye bags that were not present before it may be that there is fluid accumulation and certainly any effect from Botox is not permanent but see your injector to see if there is fluid and go from there

I routinely inject Dysport which is a neurotoxin like Botox in the lower eyelids if my patients have crow's feet lines in their lower eyelids. If they don't have significant crow's feet in their lower eyelids, I don't inject the lower eyelids. The results of lower eyelid neurotoxin injections are usually very impressive. However, I never inject more than 2 units of Botox or equivalent Dysport in each lower eyelid and usually, I just inject 1 unit. The neurotoxin can on rare occasions cause the lower eyelids to become puffy from excessive relaxation of the muscles. The puffiness will wear off as the neurotoxin wears off.

“Malar Mounds” and “Festoons” are terms used to describe skin folds, edema of the lower eyelid and swelling on the check which form as a results of sun damage and underlying forces under the skin caused by contrasting muscle action.
While some people have an family genetic predisposition to Malar Mounds and eyelid Festoons, most people develop them as a result of sun damage to the fragile skin in the lower eyelid and cheek region. We often don’t appreciate how the sun, in small doses over our lifetime, affects our skin in general and the eyelid and cheek region specifically.
Once we understand this, we see that the best way to improve malar bags and eyelid Festoons is to rejuvenate the skin layers in this region. 
My recommendation is lasers, Ultherapy and fillers, I do not recommend Botox Much
Thank you
Ramtin Massoudi, MD