Deep wrinkles/folds on checks and eyes when smiling. (Photos)

I have big wrinkles under my eyes and on my cheeks, but only when I smile. I am 43 and i dont want to use botox

Doctor Answers 5

Treating strong dynamic wrinkles and folds on cheeks and eyes without Botox

The smile lines in your case are very dynamic and hence, relaxing those muscles with neuromodulators such as botox/dysport is essential. However, using  skin tightening procedures such as Ultherapy, CO2 laser or RF microneedling can  stimulate  the collagen and improve these lines. If you are opposed to using neuromodulators, you can also replace volume in the temple and lateral cheek area with Sculptra or other long lasting fillers such as Bellafill, PDO thread lifting, and platelet rich plasma to further soften those lines. Using good skin care products with stem cells and growth factors, tretinoin, and sunscreen with physical sun block can help you in the long run as well.

Combination treatment with Botox and fillers

I believe combination treatment with Botox and fillers would be best for you. Botox injection into the orbicularis oculi muscle will soften the dynamic wrinkles around the eyes while a filler injected into the mid face such as  Voluma, Sculptra or Radiesse would provide soft tissue support to the overlying skin and improve the wrinkles you see crossing the zygoma. The results could be further improved with an energy based device (one of many RF devices available such as Infini or Fractora) as well as a good topical skincare regimen including a retinoid. 

Treating Deep Wrinkles Around Eyes

It is always important to me to customize a treatment plan based on the patient's needs and goals, so I would never push you to use something you were not comfortable using. That being said, I would ask, is there a specific reason why you do not want to use Botox or some other neuromodulator? The reason I ask is because a neuromodulator (Botox, Dysport, Xeomin) is going to be your best bet for effectively treating these lines. If you are not comfortable with that a hyaluronic acid filler could be used to superficially fill these lines, making them less obvious. Either way, I recommend seeking a board-certified dermatologist or plastic surgeon with extensive experience using injectables and one who is willing to customize a treatment plan specifically for your needs and goals.

Dennis Gross, MD
New York Dermatologist
4.4 out of 5 stars 5 reviews

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Extending wrinkles from crows when smiling

I would normally treat with a combination of fillers and Botox. If no Botox, then fillers in this area would be needed. I use a cannula and place Restylane there. Bellafill and Sculptra would also work. Good skin care and possibly an RF treatment with Infini would help too.

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Deep wrinkles/folds on cheeks and eyes when smiling

Thank you for sharing your question and photographs.  The majority of these wrinkles are best treated with one of the neuromodulators - Botox, Xeomin or Dysport - as they develop when you are moving your facial muscles and largely disappear when you are not.  Some of the wrinkles along the upper cheek can be improved with filler placement to help add volume.  See an ASPS board certified plastic surgeon to discuss your desired goals and have appropriate treatments recommended.  Best wishes. 

Nelson Castillo, MD
Atlanta Plastic Surgeon
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