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

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