Botox Alternatives for Facial Wrinkles with Long Term Results?

Hi, I am 40 years old, I had Botox once about 2 years ago, I have problems with wrinkles all over my face and specially the upper and under eye area. What is my best long term option? I would like to have something for my around the eyes area (specially below part), eyelids, around the mouth, face and forehead

Doctor Answers 6

Non Botox Alternatives for Facial Wrinkles

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Botox treats wrinkles caused by over expression (dynamic wrinkles) by relaxing those muscles. The only drawback to Botox injections is that they have to be repeated two to three times per year. The most common areas to treat these dynamic wrinkles is the forehead, around the eyes, corner of the mouth and lips and neck. Once the lines become etched in (static wrinkles) from long term over expression as well as sun exposure and or smoking, other modalities are needed to augment the results from Botox therapy. This may include filler injections for the lines with our without laser skin resurfacing i.e. Fraxel. Unfortunately, there isn't a treatment out there that would negate the need for ongoing Botox. For example, if you elected to undergo Fraxel skin resurfacing, your skin would be very smooth. This effect would not last over a long period of time if you don't continue to maintain your results with Botox therapy as you will re create static lines. Blepharoplasty (eye lift)is an alternative to treat excess skin in the upper and lower eye lids. This will not permanently remove crows feet as with expression they will return quickly. Again, ongoing Botox maintenance is important. If you are more interested in skin toning under the eyes and face and less in the lines, then surgery via eye lift with Fraxel resurfacing would suffice.

Good luck!

Manhattan Facial Plastic Surgeon
4.9 out of 5 stars 158 reviews

Botox alternatives include laser and ultherapy

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Thanks for your question. A certified plastic surgeon or dermatologist can tell you what would give you the best results. Dysport and Xeomin are similar to Botox and need to be injected every 3-6 months. They relax muscles, so they are particularly good at smoothing out lines around the eyes, eyebrows, and forehead. Injectable fillers give volume and create contours on the face, so they are great at treating lines around the mouth, for example. They generally last 6-18 months. Laser treatments and ultherapy are other non-surgical options that have longer-lasting results.

Cory Torgerson, MD, PhD, FRCSC
Toronto Facial Plastic Surgeon
4.7 out of 5 stars 170 reviews

Longer term results for wrinkles

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 Botox and Dysport work by relaxing muscles that cause lines.  They are not erasers  and will not remove any lines that are present at rest.  they should be thought of as more preventative and can smooth some early lines that are caused by muscle contraction in the area.  Lasers provide the longest term answers for wrinkles.  They stimulate collagen which lasts for years . Only ablative lasers do this very well and really the Erbium Yag or CO2 are the gold standard.  All nonablative techniques achieve minimal to no improvement when compared to ablative lasers.  Some lasers are fractionated while others are full ablative.  Speak with your dermatologist to decide which is best for you

Shawn Allen, MD
Boulder Dermatologist

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Alternatives to Botox for Facial Wrinkles

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There are several longer term options than Botox for facial wrinkles and these include:

Other injection procedures (longer lasting derma fillers) especially below the  eyes as fillers last around 9 months in this area.

Laser resurfacing including CO2, Ebrium and/or some form of fractional resurfacing.

Deep chemical peels.


Each of these will have pros and cons, but generally speaking, all will have longer lasting results for facial wrinkles than Botox.  My best advice woul dbe to go to several consultations to dicuss multiple options.

Harold J. Kaplan, MD
Los Angeles Facial Plastic Surgeon
4.4 out of 5 stars 7 reviews

Eyes will require a combination of treatments

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Dysport is a new arrival to the USA market and is a botulinum toxin product that works much like Botox and is a reasonable alternative.

The source of your wrinkles is due to many causes. There is no one solution and your best results will likely require multiple modalities including resurfacing, surgical rearrangement, skin care, chemodenervation, etc.

Otto Joseph Placik, MD
Chicago Plastic Surgeon
4.9 out of 5 stars 86 reviews

Removing facial wrinkles

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Living in the sun belt and with wrinkles all over your face, I would imagine the wrinkles are severe sun damage. A full face CO2 laser will be very useful but the wrinkles will come back if you keep being exposed to the sun. They also will come back in the areas of significant muscle function ie forehead lines, frown lines, and crow's feet unless you continue with Botox.

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.