“Crow's feet - botox complication (fat-pad herniation?)”

Hi, The muscle that causes crows feet is call the obicularis oculi muscle. This muscle is located around the eye and directly under the lower eyelid. Botox is usually injected just to the outside of the eyes to weaken the obicularis muscle and thus eliminating crows feet. Occasionally a low dose of botox can be injected just under the eyelid to soften some wrinkles in that area. If the botox weakens the entire muscle under the lid, it is possible that eyeball fat can herniate in this area. However, if it has been 6 months, assuming you had the standard doses of botox, the botox effect should be gone. Another anatomical structure usually responsible for eyelid herniation is called the septum. Weakening of the septum comes with age or can run in the family and results in fat herniation ( puffy lower eyelids). If you truly have lower eyelid herniation, I am not aware of any laser treatment that can resolve this. Lower eyelid surgery is the correct treatment and can be performed under local anesthesia or mild sedation. Hope this helps. Dr. S.

• reply