I've heard mixed reviews about Botox - whats the best procedure or treatment to help with under eye wrinkles? (photo)

I am 27, wear sunscreen everyday, and take very good care of my skin, but I have bad under eye wrinkles, particularly when I smile. I have always had some under eye wrinkles, but I feel like in the past few years it's gotten a lot worse. I have heard mixed reviews about Botox and fillers for under eye wrinkles. What is the best way to help with this problem?

Doctor Answers (8)

Under Eyelid Wrinkles Can Respond Well To Botox And Fillers Properly Used.

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Photodamage and aging are not the only causes of wrinkles under the eyes. Genetics seems to play a role as well in certain people. Especially in a younger person, where tissue laxity is typically not an issue, the use of microdroplet of Botox (and Dysport or Xeomin) injected a couple of millimeters below the lashline (in line with the pupil) and sometimes laterally, as well can help to diminish the "jelly roll" like hypertrophy of the muscle below the eyes and the crinkles. Following this, if still necessary, a tiny amount of filler, such as Belotero Balance (which doesn't cause the unwanted bluish Tyndall Effect when injected superficially) can be injected below the crinkles to further straighten them. This is a demanding location and only a board certified core aesthetic physician with experience and expertise in injecting this region should be consulted. Make sure to ask the physician to show you his/her before and after photos.


New York Dermatologic Surgeon
5.0 out of 5 stars 11 reviews

Mini Botox best for the young and the crinkled

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Older patients have wrinkles under the eye from laxity. For them, Botox is a poor choice. The lax skin must be corrected with CO2 resurfacing. But for young women, Botox, correctly and precisely injected by an expert injector (check to make sure they are board certified in the correct field dermatology, plastic surgery, ophthalmology, not OB GYN, emergency medicine, etc) is the BEST choice.  If you can make sure they are platinum or diamond injectors, or perhaps instructors at CME meetings, that can help insure you get the most expert injector. As I have said many times: it is not what is done, it is who is doing it. Patient and procedure selection is critical to good results. 

Mary Lupo, MD
New Orleans Dermatologist
5.0 out of 5 stars 8 reviews

I've heard mixed reviews about Botox - whats the best procedure or treatment to help with under eye wrinkles?

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I use "MicroBotox" injections to improve this area. Only a few experienced injector do this technique with wonderful results. Fee from $1,000... 

Darryl J. Blinski, MD
Miami Plastic Surgeon
4.5 out of 5 stars 61 reviews

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Botox is for crows feet but cannot be used on wrinkles beneath the eyelashes

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Thank you for your question.  Botox certainly will reduce wrinkling with smiling in the crows feet area and the outer one third of the lower eyelid.  However it cannot be used in the mid and inside portion of the lower eyelid.

Brooke R. Seckel, MD, FACS
Boston Plastic Surgeon
5.0 out of 5 stars 26 reviews

Lower eyelid muscle and skin wrinkles

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Botox is not indicated for this area with fine wrinkles. These lines are related to the muscle action. Do not let anyone put filler there either.  

Steven Wallach, MD
Manhattan Plastic Surgeon
4.5 out of 5 stars 15 reviews

Under Eye Wrinkles

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One of the reasons you may have heard mixed reviews about Botox is that many of the practitioners who administer it do not differentiate what it can really do and not do. Your wrinkles are from normal muscle function and Botox is not normally indicated to treat them. If, however, the muscle is significantly hyper functional, then Botox could be tried to weaken the muscle a little by someone exceptionally experienced. You have no other signs of aging and, therefore, are not a candidate for normal fillers or surgical procedures, although Belotero could be placed in the wrinkles to soften them some. Otherwise, you appear to be doing everything right. Make sure the sunscreen you are wearing is a Zinc Oxide sun block with at least 8-12% Zinc oxide, as the zinc lasts as long as you do not wipe or wash it off and the only other UVA block needs to be reapplied every 1-2 hours. Do not look for SPF, as it tells you only that the sunscreen blocks UVB. It is the UVA that causes skin damage that increases wrinkles. If your present sunblock is not an excellent UVA block, after switching to one that is you could add Retin-A to your skin care to try and reduce the wrinkling some. If you decide to peruse an injectable, make sure they are an Expert Injector.

Robert T. Buchanan, MD
Highlands Plastic Surgeon
5.0 out of 5 stars 4 reviews

Eyelid wrinkles

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Thank you for your pictures. You have  dynamic wrinkling of your lower eyelids during  animation. BOTOX is not indicated for this area of the face. It is really little option for you at this point. It doesn't appear that you have enough skin for blepharoplasty.

Earl Stephenson, Jr., MD, DDS
Atlanta Plastic Surgeon
5.0 out of 5 stars 8 reviews

Under eye wrinkles

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Wrinkles can be caused by several things, some of which can be corrected. Here's a breakdown...

1. Muscle movement - a circular muscle surrounds the eyelids and are responsible for crow's feet. If the wrinkles you make when you squint are still there when you stop squinting, then Botox will improve the appearance. It will also prevent collagen breakdown caused by muscle movement, so it can be preventative when used early. 

2. Sun damage - even minimal daily exposure can lead to collagen breakdown. Regular sunscreen use as well as sunglasses and eye creams can keep your skin as healthy and plump as possible. For lots of skin damage, skin resurfacing with laser or peel may be indicated. 

3. Volume loss - losing even a small amount of fat under the eyes can cause depressions called "tear troughs". This is where filler comes in. 

To decide which of these options will work for you I recommend consulting with a board certified plastic surgeon. Good luck! 

Dana Goldberg, MD
Jupiter Plastic Surgeon
5.0 out of 5 stars 8 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.