Fillers and Botox in combination are the best treatment for crow's feet.
If there is not a lot of sagginess to the crow's feet, you should have virtually complete elimination with these two modalities.
Botox is injected into the Orbicularis Oculi muscle which is roughly a circular muscle which runs around each eye. This causes a relaxing of this muscle. This would treat the dynamic wrinkle which is developed each time the muscle is used, say for squinting or laughing.
Then a filler can be used into the lines themselves.
If done at the same time, the filler should be done first since the volume of the Botox might masquarade the lines.
I prefer to inject Botox first and have the patient return in two weeks for the filler. That way I can better judge how much filler to use.
I prefer Restylane for this area, and will probably use Restylane Touch when it is approved in the US. Juvederm Ultra is also a good alternative. Many physicians worry about blue blebs in this area. This is a concern, but I have not seen it yet. If you are worried about this the collagen filler, Cosmoderm is quite useful. However, this can cause little bumps, though they go away after a few weeks. A future alternative collagen filler will be Evolence Breeze when that is approved in the US. It is meant for areas such as the crow's feet.
By combining treatments, one gets the benefit of Botox, which decreases the muscular tension and lets the filler last longer.
Thank you for the great question.
