When I smile a hard crease is created as cheek rises and meets my under eye. Crease occurs directly at bone under eye.

Question

My Medspa put 2 units under each lower lash line when botoxing my eyes but it resulted in the crease becoming more pronounced. (I've also done some filler to get rid of a nasojugal groove, so that may have added a bit of fullness) Is this something where blepharoplasty is the solution? I've included pics without Botox and then again with Botox in the jelly roll of my eye. You can notice the difference in harshness of line. These are all w/in the same week. Thanks in advance for any insight.

Kenneth D. Steinsapir, MD · Answer

Don't fix bad filler and botox service with unnecessary surgery.  Your mistake was to trust that your "medspa" actually know what they are doing.  Many of these places represent the unauthorized practice of medicine.  In my opinion you are improperly filled and almost everything stems from that.  You are headed down a horrible downward spiral if you seek out eyelid surgery from someone who does cookie cutter eyelid surgery. This is how it starts: bad filler and botox treatments that lead to bad cosmetic surgery.  Often the effects of the surgery are either unfixable or very expensive to fix.
What you need it to do is take out the fillers that are making you look older than you should by providing unneeded volume in the wrong places.  Let the botox where off. Placing botox in the lower eyelid has simply weakened the orbicularis oculi it is harming your appearance.  You need to have hyaluronidase for the funky cheek filler treatments that are making you look older. Once the old filler in the lower cheek is out, judicious filler can be placed in the tear trough and the mid cheek groove.  This will almost instantly make you look 10 years younger.
You also have bilateral upper eyelid ptosis with a compensatory eyebrow elevation.   You have a particular type of upper eyelid ptosis that is cause by a levator disinsertion.  It is essential to know that this type of ptosis does not respond to posterior approach upper eyelid ptosis.  Your potential surgeon will not know that.  The posterior approach ptosis surgery is also known as a Mullerectomy (MMCR-Muller's muscle conjunctival resection ptosis surgery).  This surgery removes tissue on the back of the eyelid (no skin incision) and forces a fold in the levator tendon to help lift the upper eyelid.  The surgery is so popular because it is easy for the surgeon.  However, with the levator not inserting onto the tarsus, this surgery will not work.
Hope this information makes sense to you.

Brian Kiesnowski, MD, MPH · Answer

Hi! I can definitely see your concern regarding the under eye "roll."  Have you had a consultation with a plastic surgeon regarding this issue or have you just been using a variety of medispa treatments under the advice of an aesthetician or nurse injector? I never out botox under the eye except in the case of blepharospasm and that is rare. Most blepharospasm occurs in the upper eyelids. Whenever you paralyze the muscles there is a risk that the other muscles will overcompensate for the loss. This appears to be the case based on your photos. It is possible there is entirely something else going on. Without physical exam it is impossible to say. The good news is that your botox will wear off. Once that happens, see a board certified plastic surgeon for an opinion on surgical repair. It is important to make sure that you wait until the botox has worn off so that the surgeon  an get an accurate representation of your problem.  It is also likely that the price of a surgical repair might be less than the aggregate amount of money that you would spend at the medispa and your results might be more pleasing to you. 
Good luck and do post new photos if you decide to go a surgical route.

When I smile a hard crease is created as cheek rises and meets my under eye. Crease occurs directly at bone under eye.

Answers (2)

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When I smile a hard crease is created as cheek rises and meets my under eye. Crease occurs directly at bone under eye.

Answers (2)

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Everything you need to know about Eyelid Surgery

Our mission is to create a world where every investment in modern beauty is Worth It.