Can Botox ease extended crow's feet? If not, will microneedling work? (photos)

Thank you for the question. You submitted 2 photos and describe in your question that you received Botox™ for the first time in May, and after you were concerned about the lines that radiate onto the cheek past the crow’s feet lines. The people who performed this for you did an enhancement, but also, suggested microneedling. You ask about the benefits of potential microneedling for these extended lines beyond the crow’s feet lines.

I can certainly guide you with this question. I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial plastic and reconstructive surgeon practicing in Manhattan and Long Island for over 20 years. The frustration people have with wrinkles around the eyes and beyond are things  I deal with everyday in our practice,and I have a lot of experience with multiple modalities, including microneedling.



Let’s start with a global perspective as to why you have those lines. We want to distinguish basically 2 terms when it comes to describing lines: dynamic lines form when you smile because muscles are contracted, such as the orbicularis oculi muscle around the eyes that cause crow’s feet lines; the cheek lines happen when the cheek moves up, so you get an accordion effect that causes those lines to get deeper and go further out, which are called static lines because they are present regardless if you are moving a muscle or not. This is a little confusing because the cheek is moving, but if you possibly lift the cheek, you’d see the lines form. What you are dealing with ultimately is the long or lifetime effects of the combination of aging, sun exposure, movement, as well as genetics.



Trying Botox™ for the first time is your first step in the world of many options. The way I approach someone like yourself in my practice is I try to have you look at the big picture. Very often, I’ll take a patient’s photo and I’ll put it up on the screen, and go over the photo with them in detail about the different issues. It is very common and normal to focus on one specific area, but when you think of the global appearance of the eyes and the cheeks, there are other areas I suggest you consider evaluating: look at the hooding around your eyes, the lines beyond the cheeks and throughout the face. Think about a solution which is more comprehensive. If you chase lines, you will be frustrated, but if you understand the dynamics and capabilities of the different modalities we offer, then you can get a sense of how to strategize, and what your realistic options are including microneedling.



Microneedling creates little openings in the skin, and the depth can be controlled. The point of microneedling is inducing these fine injuries at the epidermis to dermis level to stimulate a collagen response to help improve the wrinkling. In other words, there is a loss of collagen in the area called the dermis, or the backbone of the skin. The epidermis, or outer layer of skin, would probably benefit from some type of resurfacing procedure.



In addition, we  maximize the effects of microneedling in our practice with platelet-rich plasma (PRP) which is derived from your own blood. I actually apply PRP on top of the skin to help stimulate more collagen as a response to help improve skin quality. What is missing in this equation is skin  tightening, which can be done with thermal devices such as lasers, whether it is non-ablative, fractional or ablative laser. When it comes to the results, you have to think about your tolerance for downtime and recovery.



I know this is all new to you, but I recommend you understand what these different modalities can offer you so you don’t feel frustrated and dissatisfied with a procedure that doesn’t deliver a dramatic outcome. So much of this is about communication, and it is really about figuring out what defines success for you, what you are willing to do, and how it can be integrated into your lifestyle. Fortunately, there are many options. We offer in our practice, for example an Nd:YAG laser that is non-ablative. We offer Erbium laser that’s both fractional as well as non-ablative, also the CO2 laser,  radiofrequency, and microneedling. There is a reason to have many different tools because you want to be able to customize the options to help your patients achieve a desired result. I hope that was helpful, I wish you the best of luck and thank you for your question!

I suggest a combination approach with lasers, fillers,skin care and microneedling/PRP for treatment of under eye wrinkles. Botox can also be used in combination with other fillers used more superficially. We have also seen great improvement in patients that use Clear + Brilliant after microneedling for aging. Please seek an expert for a consultation. Best, Dr. Emer

For lines that cannot be treated with botox, you need a collagen induction procedure. Microneedling is an example of this andocument does stimulate new collagen growth which will improve wrinkles. Expect to do 6 of them about a month apart. If you do it WITH PRP- the so called Vampire Facial- you may be satisfied with 3 or 4. Another option is to do an Ultherapy smoothing treatment around your eyes- this is a stronger treatment and you will likely be pleased with results if you do a series of 3.Best,Lisa Vuich, MD