Under eye wrinkles when smiling: I get VERY small amounts of Botox for my crows feet. (Photos)

Thank you for your question. You are asking about under eye wrinkles still appearing after you had conservative Botox treatment for your crow’s feet. You are asking if filler can treat them. You indicate that you had Fraxel done in 2015, which worked out well for your skin, but you are still frustrated with under eye wrinkles.
I can certainly help guide you with this question, based on your photo alone, and without the benefit of a physical exam. I’m Dr. Amiya Prasad. I’m a Board Certified Cosmetic Surgeon and Fellowship-trained Oculoplastic Surgeon. I’ve been in practice in Manhattan and Long Island for over 20 years. As an oculoplastic surgeon, we were among the first doctors to administer Botox to patients for hemifacial spasms, even before it became a popular cosmetic treatment. I am well experienced in applying Botox to different areas of the face such as crow’s feet lines, forehead lines, the Botox brow lift, the chin, and also for the mouth area as the Botox lip lift.
While Botox can help with crow’s feet by reducing the activity of the muscles, I would not advise doing the same for the under eye area, which you are already aware of due to affecting facial movement and expression. You mentioned having Fraxel laser in the past. Although I don’t currently use the fraxel laser in my practice, I do use fractional lasers like Nd:YAG, CO2, and Erbium, as well as radiofrequency devices like Pelleve for darker skin, to treat wrinkles under the eyes. These devices can tighten lower eyelid skin, and induce a collagen response to help improve wrinkles and skin quality. Lasers and radiofrequency devices generate heat into the under eye skin, and the body reacts through contraction and by generating collagen as an injury response. It is important that any thermal device used is done by an experienced practitioner to avoid overexposure and overheating, which can damage the skin and the essential fatty layer beneath the skin.
To avoid overexposure, but still generate collagen, I also treat the under eye area with platelet-rich plasma, or PRP. PRP is the concentration of wound healing and growth factors present in your own blood, and responsible for healing cuts. We draw your blood, then concentrate these factors using a centrifuge. When this concentrated serum is injected into lower eyelid skin, it stimulates collagen in this area, increases blood supply, helps with discoloration, and can thicken the skin. PRP improves the overall health and quality of the lower eyelid skin. Combining PRP with laser treatment, or alternating it with laser treatment, has helped many of my patients improve their under eye wrinkles.
With under eye wrinkles, it’s important to keep in mind that we can improve the appearance of wrinkles, they can’t be eliminated entirely. If you define success as improvement, then you will be happier with your results.
I suggest you meet with doctors who practice cosmetic laser treatment, PRP, as well as Botox so you can have unbiased recommendations of what you can do about the under eye area. I hope you found this information helpful. Thank you for your question.

A combination approach will give the most improvement. Botox combined with fillers, lasers, and microneedling/PRP can improve under the eyes. My patients try to get non surgical treatments to avoid surgery. We use PRP and stem cells there often. I suggest consulting with an expert to develop a treatment plan best suited for your short and long term goals. Best, Dr. Emer

Under eye wrinkles after botox can be corrected with a small amount of botox in the lower lid itself to prevent recruitment of that part of the muscle.  A tiny amount is all that is needed and will have no negative effects on a person without significant laxity of the lower lids (usually older patients).   In addition resurfacing treatments like fraxel, co2 lasers, erbium lasers, or chemical peels can improve the texture of the lower lids.    Filler could improve the hollowing of the lower lids but won't improve the undereye wrinkles when you smile.  Best of luck.