Why Doesn't Botox Work on my Crows Lines?

It is useful to think of dynamic (from movement or when the muscle functions) and static (at rest) wrinkles or lines. Botox will diminish the function of the underlying muscle and improve those lines or wrinkles that result from the muscle contracting. If thre is a fixed line when the muscle is at rest, then it may not be improved with Botox. But there are other options that may help. In our youth when our facial muscles function, a line or wrinkle may is created, but it goes away when the... more

Botox relaxes the muscles, but your lines and folds are probably etched in your skin. In addition to Botox, you probably need to smooth these folds with fillers like Juvederm. If fillers don't help enough, the next thing to try is laser resufacing. This can be either superficial or deep resurfacing and I use the Contour or Profile laser manufactured by Sciton.

Every time we make a movement with the upper face, a crease is made in the skin. When we are young the crease goes away when we relax the muscle. Over time that creases get deep, and are visible even when the muscle is relaxed. Your creases may be so deep that simply relaxing the muscle isn't enough. It may take months or years of having Botox to keep the muscle relaxed, fillers to replace lost volume, retinoid creams to improve the skin texture, and laser rejuvenation, in order to see... more

I agree with Dr. Shafer. I would add that if you are not ready for surgery speak with your cosmetic surgeon about other less invasive procedures to help diminish these lines. Besides wrinkle fillers, thermage and fractional laser skin resurfacing can help to further diminish these ocular wrinkles. As an Ocular Plastic Surgeon I use a combination of thermage and the Mixto laser in my Sterling Heights, Michigan medical Spa for this goal.

This is a great question. Botox works by paralyzing the underlying muscles, which prevents the formation of wrinkles by preventing the muscle from bunching up the overlying skin. For mild wrinkles at rest and wrinkles that are only visible when you contract your forehead or orbicularis (the muscle causing crow's feet), Botox is very effective. For deeper wrinkles that are present even at rest, Botox is less effective. This is because over years of the constant stress on the skin which... more

There can be a few factors that may contribute to a less-than-hoped-for Botox result. It is important to remember that Botox only works to relax the treated muscles that are injected. It does nothing to the overlying skin.      If the wrinkles are deep and long-standing, Botox will have to be in place without wearing off (injections repeated at 2.5 to 4 months as necessary) for many rounds to allow the skin to stop re-creasing between treatments.  If the... more

Botox is very effective on the crow's feet.  It certainly will not treat "etched lines"( deep lines) that have basically adhered to the udnerlying muscle. Sometimes patients present after treatment and do not udnerstand that when the cheek elevates with a smile the skin can wrinkle.

There are various reasons why your Crow's feet are not improving sufficiently with BOTOX. The injection technique may not be perfect, you may be underdosed, or you may not be a great responder to BOTOX and may require the addition of a filler if the Crow's feet are deep when at rest (not moving). Sometimes a fractionated laser can also be very helpful or a skin-tightening agent like SkinTyte or Thermage.

It is important to understand (as Dr. Gross said) the difference between wrinkles at rest and while moving. If you still have wrinkles that bother you AFTER Botox, you are not alone. Many patients need combination therapy. The actual combination depends on many factors and a discussion with your treating doctor. I prefer to use fillers like Juvederm in the crease to make it less visible. In some patients, I use Fraxel laser to help with the creases. However, I do think that the deeper the... more