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That's certainly not my most flattering picture, but since the malar bags (puffy under eyes) I got after my last Botox injection have mostly gone away, I needed to tilt my head to let you see them. This is NOTHING like how they looked a few weeks ago, but I couldn't bear to take a picture at that point, being too worried that I'd forever disfigured my face after getting Botox injections in a site on my face I never had before. (read more) MALAR BAGS FROM BOTOX
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PUFFY UNDER EYES AFTER BOTOX
WHY DOES IT HAPPEN?
Basically, you have lymph glands under your eyes (I've included a picture below), and when you get Botox or other paralyzing injectables under your eyes (or in places where the Botox might drain under your eyes) you can and will paralyze the muscles that work to push the lymph away.
When these muscles get paralyzed, they stop moving, and the lymph that was otherwise being squished on to other places is now just sitting, pooling behind the thinnest skin on your body. Once enough lymph builds up, you get an unsightly bulge, and that's called a malar bag. This happens fast, just a few hours in my case, worse in the mornings, and even worse as the day progressed.
Now, this is just one reason you might get puffy under eyes from Botox injections. The other thing that might be happening is that your now lax under eye muscles have allowed any fat padding behind the muscle to pop through, meaning the bag you're seeing isn't lymph, but fat.
I'm not sure how you'd tell the difference between the two, but I would think a general idea might be whether or not your bags get better (or worse) during the day or in the morning, or if the bulge tends to stay the same throughout the day.
Here's that picture, so you can see how your body drains the lymph, and why it might not be happening once you paralyze the muscles.
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PUFFY UNDER EYES AFTER BOTOX
​HOW TO FIX IT
Whatever you searched for to get here, whatever you want to call them, the answer is sadly, yes. Also sadly, I haven't been able to find anything that promises to fix puffy under eyes after Botox, though a few replies on Real Self seem to think that it can be helped.
For those of you who have bags under eyes after Botox for crows feet (or whatever), I feel your pain, and I get that you want it to go away, but I'm going to issue a word of caution. For me, I chose not to correct it with more injectables, feeling that any correction would have unknown consequences once my muscles started working again and that lymph began to flush as intended.
If you choose to chase this problem with further correction, my concern would be that anything you did would not have the end result you want long term. For example, if you choose to add filler to diminish the malar bag, what will that filler look like once your Botox has worn off, but your filler is still going strong?
I didn't feel like the risk was worth the reward, so I let it be as far as seeking out any treatment. However, I did read a few things that might help diminish the appearance while you wait for your Botox to wear off.
1. Drink lots of water. If you're retaining water because of a high salt or high alcohol diet, staying hydrated can help. I noticed this on myself one day after eating most of a bag of Doritos. It was a lot of salt and the next day my bags were terrible. I made sure to drink a lot of water and that really helped.
2. Cut down on the salt.
3. Cut down on the alcohol.
Anything that can make you feel puffy and bloated is not something you need in your life right now.
4. Try sleeping in an elevated position. I noticed that my bags were always worse on the side I sleep on. Being a left side sleeper it meant the left side of my face had a much larger bag than the right side. An elevated pillow can help, if you're able to sleep on your back at night. I already had one on hand from when I had surgery on my arm, so that was an easy fix.
5. Ice packs. Anything you'd use to help un-puff (I made that up) your face in the morning will be a good thing right now. If you have a gel pack to cool your eyes, a bag of peas, etc. that might take some of the swelling down.
6. Antihistamines. This is something I read on the boards I was looking at. Some of the women thought perhaps their under eye bags were worse because it was allergy season, so they kept up with their antihistamines and noticed diminished swelling. I'm not advocating taking an antihistamine if you don't already take them for allergies, just don't forget them if they're a part of your normal routine.
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BOTOX CAUSED UNDER EYE BAGS
HOW LONG WILL THEY LAST?
If the reason for your bags is that the fat pad has poked through the lax muscle wall, I would think that would resolve as well when your muscles get their ability to move again.
However, some women have reported their under eye bags worse after Botox and that this didn't go away. Some of the posts go back years with the women stating that the bags are still there, where they either had not been before, or had not been as bad before.
I would think, in most cases, the bags will go away once the Botox loses its ability to work. Once that happens, the lymph will begin to flush again, and (hopefully) if you're dealing with protruding fat, the muscles will once again close over it.
That said, I think that the women who have long lasting issues with this are the women who have the fat protrude and it doesn't go back, for whatever reason. But, that is my totally non medical opinion.
I go for Botox about twice a year, so I was ready to wait six months to see things get back to normal. Thankfully they got back to normal (mostly) after about two months, and I hope they continue on that path.
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PUFFINESS UNDER EYES AFTER BOTOX
​FINAL THOUGHTS
For me it's just too much of a risk. That skin is very thin, it's very likely to show any imperfections, and even though we're told Botox will wear off at a certain pace, you can't quite be sure what the side effects will be while it's at its strongest.
Since this is not the first issue I've had under my eyes (I did get filler once, and it's still there, though it's been almost 4 years and everyone says it can't possibly last that long), I know that I'm susceptible, so I'd rather stay away from it altogether.
If you are a person who wants to continue getting Botox under your eyes, but you have had a problem with the bags, speak to your injector. Let him or her know what the issue is, see if there's something they can do like possibly injecting less, or injecting further away from the lymph nodes, etc.
I hope this has helped, and by all means, if you have any questions, let me know. I'm always happy to help if I can.
Ty
Hi Ty,
thank you for your candid post and sharing your story! you have no idea what relief i felt finding your blogpost as i ruminated what had happened to me and if i will be “disfigured” forever. my story resembles yours - i have had botox for 2years and die to covid couldn’t travel to berlin, so found another injector here that i was recommended by a friend. he looked at me carefully and suggested injecting botox under my eyes as i have thin skin that is crepey when i smile. i had one injection under each eye and several to my forehead - 2 weeks later my check up- not much change, a little puffy eyes- he suggested injecting more and gave me 3 addtl under each eye. the next few days i got puffy eyes like if i had allergies, but not directly an eye bag but further below and more severe on my left eye. even my mom commented. i felt terrible, i felt tension when i smiled and my skin was taut and even more wrinkly when i smiled - i felt beyond ugly and worried that i ruined my face. searching online and realself and becoming very confused and worried reading others stories, looking older than before and fearing i have irreversible damage (not to mention the money down the drain). how has it improved for you now? it’s been 3 weeks since my second injection and it has gotten a littler better already. i will have a follow up with the doc - who on the phone indicated we should inject more - but i will decline - forehead maybe, but under the eyes just seems like a poor idea. please tell
me that you see further improvement and give me hope :) and i will for sure wait until the botox effect wears off (it was allergan) and then try to travel again to my precious doc (galderma). your article gave me comfort and hope! thanks
isabel
Hey Isa. I can reassure you that my bags are gone now. It took a solid two months, maybe even a bit longer, but they have disappeared. It was subtle at first, and they would go away then come back, but eventually they didn’t come back, not even after a meal with more salt than I normally eat. I will also never have any injections under my eyes again. I’m glad you declined further units. Hopefully yours will go away totally in the next few weeks!
Thanks Sheile, I am glad to hear its getting better for you and i keep my fingers crossed it will reverse in my case as well - with time. it’s a bit better already but i also see some days are milder and others show greater bags although i may have had a lot of rest. and they are not the “typical” eye bags, as they sit lower, like a second ring on top of the upper cheekbone. oh well, i will have to be patient and see it wear off and let that be a lesson for future injections ;) take care and thanks for sharing your story! isa
Isa, have you had any luck with their going away on their own. I am in the same spot. I had the botox on 10/19 and they are still there. I am so frustrated.
Hi I have this awful problem I’m laying in my hotel bed in holiday and I feel totally ugly I gave big droopy eye bags due to Botox injections ,really puffy and saggy in the morning do get slightly better through the day but not much .I just want my face back to normal it’s so upsetting and only been 3 weeks so I have weeks to wait 😪x
Hey Donna, how is it going now? It's been what, a couple of months? Are the bags any better?
Hi, love it’s been around a month they are better but not normal still have pouches I never had before but thankfully not as bad!i had my lips injected with 2ml of filler never again this isn’t my face at all I have learnt a hard lesson from now on just gonna be me I look
So much prettier without all that shit,can’t wait for it to all be gone xxx
I had dysport in December beside my eyes and my swelling never went away. I'm quite upset it damaged my eye shape as I never went back to normal and the swelling is worse and unpredictable. I'm in my 20's so I should have never ever had it in the first place the woman who did it was a psychopath honestly. I have huge eye bags now too that were not as bad before. Like the muscle has totally been eaten away. Stay away from eye injections. They can cause permanent damage 100% because it happened to myself.
Hey Anna, I'm sorry you're going through it. Has it been a whole year almost and you're still having problems? Have you been to see anyone about it, maybe you could get an injection to dissolve anything that might be left? Yes, I agree with you about getting stuff done around our eyes, it's so easy to be talked in to it, but the results can be really terrible and quite unpredictable.
Hello Anna how are you now? Any difference?
Hi Anna.. How are your eyes/bags now..?
I have the same story... I am waiting now 6 months already but its not much better. :(
OMG the same thing happened to me the injector is denying this and my problem is so bad and I DIIDN'T ASK HER TO INJECT THE SIDE OF MY EYES!!!!!! its almost 3 months and I look like a freak!!! Im going to another pastic surgeon to see if he can help me and I looked so beautiful before I got free botox because I got breast implants
Hi Deborah. I am so sorry you're going through this. :( I just want to clarify, she did inject the side of your eyes, right? Or did she not inject the sides of your eyes and the Botox traveled? I am due to go back in for a touch up, and I am definitely not letting her anywhere near my eyes, I may not even let her do my crow's feet.
Let us know what your doctor says. Everything I have read says that you should not chase it with correction and that it will resolve on its own, but I'd like to hear what a doctor says.
Mine is resolved now, but it did take a solid three months to go away, maybe even a bit more.
I hope this passes for you soon.
Thanks! I’m going to see another plastic surgeon this week it looks a tiny bit better that’s all! I’m so upset Becki never asked the PA to inject my eyes on the side!!!!
I learned a lot from your post. AGree about the deniers on Realself. :) I have had Dysport or Botox for years. I am usually very pleased with the results, but I ended up with unsightly bags like Isa described, "as they sit lower, like a second ring on top of the upper cheekbone." They appeared a few days after being injected. My injections were forehead, sides of eyes and my "elevens". My eyelids are also more hooded than they were, which was the reason to go in. I followed up at the two week mark and the injector (new to me as I moved) told me that it was swelling, advised me to do Benedryl at night, which I haven't done yet. But, I look so much worse and will probably not do injections again. I hope it goes away soon. Will try the more water route and pray that it wears off. The other thing the injector told me was that I was unfortunately among the 26% of people who have this side-effect. 26%? Those aren't great odds, IMO.
P.S. I have found that I cannot have forehead injections at all as they increase my hoodedness. I told the injector that and he said it wasn't the case. I have to learn to be my own advocate. I know what I know and should have insisted that I not get this injection site.
Hi Nancy, I'm so sorry you're having this issue. I hate that it appears to be so common, yet it's not something any of us were told could even be a possibility. I'm so nervous to have any more Botox, even the frown lines on my forehead. This is definitely something where we need to look at the possible side effects and ask ourselves whether or not losing those wrinkles is worth it...
I hope your face is back to normal quickly.
Hi Nancy,
sorry to hear!
it’s been a little over 2 months for me now and it had gotten better, but not gone yet. when i tilt my head like Ty did on her photo, it’s still there, and mostly on my left eye. Some days it is better and barely visible, on other days it is back and a bit more severe. I don’t have an explanation and cannot see a direct correlation to salt or food intake. you will have to be patient, but it should get better and hopefully it will fully reverse after 4-5months...
i found a video on youtube that was very enlightening for me - here it is (i have no affiliation with them, just searched for side effects botox and this came up) https://youtu.be/7UqSXw-4MKU
take care, ladies!
That was a super clear video. Thanks for sharing.
Where did you read about the 26%
I didn't read about it. The injector mentioned it when I went in to complain two weeks after my injections.
THANK YOU FOR POSTING THIS!!! My crows feet were starting to show because my last Botox was wearing off. The lady I went to added some Botox in the crows feet area and she asked if I wanted some for my bunny lines too. I'd never gotten Botox near my nose, but I said sure. Big mistake.
1. When I smile, the skin under my eyes crinkles in a way it never had before. It almost looks like reverse crows feet that start at the bottom corner of my inner eye.
2. When I smile, my nose looks longer, like the tip points down more. I look kind of scary, like a witch, so I have been trying to smile differently.
3. The skin under my eyes and on the top of my cheek look older, tired. I did have dark circles under my eyes, but not bags. Now it looks like I have bags.
4. The skin where my bottom eye lashes are also look puffy, especially in the morning. One eye looks puffier than the other. I think this is called a jelly roll and it looks like it's bulging.
5. My overall face looks different. I really think that bad Botox changed the features of my face. Can't wait for this to wear off.
It was a huge mistake getting this Botox done. I did it hastily because I was going to see family in a few days and I didn't want them to say anything about my crows feet. Instead, they noticed the lose skin under my eyes. I also had a to postpone a full face fat transfer procedure I was going to get done for my birthday to correct all the volume loss I've had, but because of this bad Botox, I had to postpone the procedure 5 months so all the effects of the Botox wears off. Lesson is to only go to doctors who really know what they are doing, and not make quick decisions regarding altering your face. I usually only pick the best doctors, but I messed up this time. I'm seeing this as a blessing in disguise because at least Botox is reversible. This is making me see how easy it is to mess up one's face, and that maybe a few crows feet aren't so bad. I don't look like me right now. I miss me. When I look at pictures from before the bad Botox, I think I looked so good then. Funny thing is that back then, I didn't think I looked so good. This has taught me to appreciate my natural look, my real smile, with crows feet and all.
Hi Elena. I am so sorry you had this reaction as well. Hopefully it does go away soon. Like you, I believe I'm going to be too wary to continue with any sort of Botox. I will stick to chemical peels, but anything beyond that...I think this has scared me off of it. You just never know when something like this could permanently affect the features of our faces. :( Mine did go away, so I have high hopes that yours will as well.
Hi Ty, I experienced the same thing over a year ago. It got better, but didn't go away completely. Unfortunately. I swore to never do Botox for my crows feet again, but here I am, tempted to just do the sides and the upper part (no injections below the outer corner of the eye). So same as you actually. Therefore I wanted to ask whether you already did it. And if yes, if all went well.
Does anybody else have experience with that?
Feedback very much appreciated.
I go to a well-known dermatologist in NYC where I have had some filler to cheeks and Fraxel. I have not had Botox in the past but this doctor suggested Botox. The first time was fine. They do Fraxel, filler and Botox on the same day. I went in for all three in early October. Two weeks later, I saw bags under my eyes and another set of bags/lines on cheek. It has been just three months,still have them. The skin under my eye/upper cheek is wrinkly which it never was before. My under eye area was always smooth. I am hoping this will resolve by the 4th month-end of January. (??)
It is confusing as I don't know whether it is filler or Botox causing the problem although I have never had anything like this happen before with filler.
I am wondering how others that posted are doing? Any other info is appreciated.
Hi Margo. I wish I could say whether it was the filler or Botox, but there's really no way to tell. My bags are gone for the most part, but it has been 6 months. I still don't feel that they look like they did before, but it's definitely close. Hopefully your face will go back to normal and then you can try just the filler or just the Botox and see if one or the other causes it to happen again. Or, you might be like me and end up swearing off anything aside from chemical peels. I'm sorry I can't be more helpful.
Hi Ladina!
I have the EXACT same issue. I am horrified by it. It wasn't until just today that I realized the cause of this. I thought at first it was just due to my aging and/or too much salt intake and alcohol. It's worse to know that a procedure, for which I paid a lot, caused this. I am praying it goes away. I dind't notice this issue until about 3 weeks after the Botox. It was the first time I increased my crowsfeet units; this is now the result. My biggest question: WILL this go away?
Like Sarah,my under eye bags did not show up until two weeks after injections. I am curious to hear from others if they are back to normal and how long it took It has been 3 months for me and I have read Botox can last until 4 months and sometimes longer. Be good to hear from those who have had resolution and how long it took. Anyone do anything to help the situation?
Thank you so much for this article. We need to speak up about this and not let injectors and the industry get away not fully informing patients of risks. I have had several different people do injections. Not once has anyone followed up about their work. I also appreciate the light shed on realself which seems more patient centered than it really is.
hi i have the same problem'
i've done this 3 times before never had any problem
since i moved to vegas found a new one
this happened
and it's already been 3 month .........
Ladies thank you all for answering this post. I had the EXACT same experience with my Botox. I went to an incredible med spa the first time I ever got Botox and the lady did a fantastic job and took her time. The second time I went, I was out of town and did it in a rush before Christmas. HUGE mistake. The lady literally injected me in less than 10 minutes with 40 units, which really disturbed me. I told her I was worried and sketched out at how quickly she did that, but two weeks later, my under eyes looked fine. No major swelling. It has now been a little over 4 weeks since I got injected, and a few days ago, I noticed absolutely horrible bags under my eyes that were so puffy. It looks as if I have ledge of fluid build up that looks worse based on the ways I position my face. In one position, it legitimately looks like I got punched in the face because of how puffy they look. My face looks completely different as a result. I’m terrified of my face never looking the same again. My wrinkles now look even worse and MORE “crepe-y” than before. I’m furious and scared and panicked. I’m never getting injected under my eyes again. But I just need some hope that they will start going back to normal because call me vain all you want, I legitimately can’t stand looking in the mirror at myself now and just want to cry every time I do. It’s really affecting my life and I’m scared... thank you ladies for all your stories and support. Y’all are helping me through this ❤️
Hi Megan,
I had the exact same with regard to timing. The bags came overnight four/five weeks after my last treatment. Apparently this is when the Botox is at its max. This is now almost 1.5 years ago. It got slightly better, but my bags are still there and they are always the worst in the morning. I went trough the same emotional breakdown as you and I still can't accept it. Ever since it happened I did a lot of research, talked to many doctors (some denied this is caused by Botox) and now I decided to do lower lid surgery, because the Botox has clearly worn off a long time ago. You may be luckier than me and eventually it will get better. If not, you may find comfort in the fact, that you can have the bags removed with surgery. I found this page that provides a lot of info (also why the bags are worse in the morning): https://prasadcosmeticsurgery.com/lower-eyelift/ I don't know this doctor (I live in Switzerland), so please don't take it as a recommendation. I just find it pretty helpful. And it's a backup plan :)
All the best for you.
Hi Ladina,
Thanks for writing and giving an update with your information. I am wondering what you tried and what if anything worked to help the situation?
Have you/ had you considered Thermage , laser or radiofrequency therapies? I am about 3 1/2 months from the time of injection and feeling distressed.
I have been waiting 4 months now for my bags to go back to normal, they are better but definitely different from before, I'm praying in another few months it goes as it has made me look older and tired. The injector added a little bit of filler a couple weeks after the botox to try and puff out the droopy ledges, I'm not sure if its the filler looking lumpy now or the botox?never again.....I really hope with all my heart all you ladies go back to your normal selfs we don't deserve this.my injector tried telling me she had never heard or seen it before and that my eyes where baggy in the first place ,they wasn't at all and she didn't believe the botox had caused it ...PLEASE..!!
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