Can botox for crows feet or filler under the eye cause the malar festoon line to become more visible? (Photo)

I recenetly got botox for my crows feet and a little filler right under the eye, every since the treatment I noticed my malar festoon lines are very noticeable even when I'm not smiling. Before the two treatments I could only see them (and much less then now) only when I was very tired. Could this have happened because of the filler, botox or both? How can this be fixed, its really bothering me, I think I look tired all the time now. Thank you for your answers.

Doctor Answers 6

Festoons after botox and filler

Thank you for your question and photo. Botox is very unlikely to accentuate malar festoons. However, filler under the eyelid is a very delicate procedure that is best for very specific indications. It is possible that the filler was placed in a position that could be causing your concerns. The good news is that the hyaluronic acid fillers (i.e. Juvederm, Restalyne) can be dissolved.

I recommend you discuss these concerns with your injecting physician.

Best Regards,
Dr. Stutman

Scottsdale Plastic Surgeon
5.0 out of 5 stars 6 reviews

Botox around Eyes

Botox around the eyes can cause the under eyes and festoons to worsen.  Filler and fractional laser (fraxel) or fractional radiofrequency (Viva) can be helpful in these situations.  Fillers placed with cannulas too can help.  Best, Dr. Emer.

Jason Emer, MD
Los Angeles Dermatologic Surgeon
4.8 out of 5 stars 190 reviews


The malar festoons may get more noticeable after injecting Botox or Fillers around that area, there is more fluid retention in the area, especially after sleeping, when the patient wakes up. Contact your physician and discuss your concerns, and follow the recommendations. One thing the patient can do is to avoid too much salt intake, elevate your head when you sleep, so there is less water retention on the face, avoid the heat and direct sunlight over the area.

Juan Carlos Fuentes, MD
Mexico Plastic Surgeon
4.7 out of 5 stars 65 reviews

Visible Festoons After Botox And Fillers

Hi Ulibka. It would have helped to see some before pictures as well to assess the degree of change after your Botox and Fillers. The problem can be fixed in a variety of ways, but it's best for an in-person consultation and evaluation to determine which treatment would be best for you. Best wishes.

Michael A. Zadeh, MD, FACS
Sherman Oaks General Surgeon
5.0 out of 5 stars 10 reviews

Festoon Lines Fix

Hi Ulibka.  If you are concerned about the horizontal indentations under the eyes and at the upper cheek, then Radiesse, Sculptra, Perlane or any number of other dermal filler products would be appropriate.  We prefer Radiesse or Perlane in this area because the products are thick and hold well in the deep tissue of this area.

To see a very dramatic example of this type of repair with dermal fillers, see the before and after photos at the link below. 

Harold J. Kaplan, MD
Los Angeles Facial Plastic Surgeon
4.3 out of 5 stars 6 reviews

Complications from Botox and filler

Both swelling and deactivation of muscles are possible after filler or Botox injections.

It's best to see the doctor who did the injections and express your concerns.

There are many subtleties with filler and Boox that could fill an entire book, so it's best to do such consultations in person.

Brent Moelleken, MD
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 177 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.