Best Treatment for Dynamic Wrinkles?

I'm desperately seeking some help for the deep lines or wrinkles that appear under eyes when I'm smiling. I don’t have the typical crow’s feet, just these deep lines under my eyes that appear when I smile. It's still visible when I'm not smiling, but not significant. Are there any treatments to address this problem, because I certainly don't want to stop smiling.

Doctor Answers 6

Dynamic under eye wrinkles

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Botox is the easist solution for dynamic wrinkles, that is wrinkles that occur only when the patient is animating.

For wrinkles elow the eye, your doctor should be careful not to be too aggressive. Why is aggressive Botox around the eye potentially bad?

Aggressive Botox below the eye deactivates the orbicularis, the circular muscle that surrounds the eye. While it may effectively reduce wrinkles below the eye, it can cause the cheeks to droop, giving an odd, apple-like bunching when the patient smiles. Also, the muscles that elevate the lip are close to the lower eyelid and can be inadvertently deactivated, causing the lip function to decrease, often asymmetrically.

When the problem becomes worse than what traditional Botox can handle, some patients consider a cheeklift. There are many types of cheeklifts. We prefer the LUSIC (LiveFill ultrashort incision cheeklift), which elevates the cheek tissue and supports the corner of the eye, preventing it from dragging down and rounding, as can occur with a treaditional lower eyelid blepharoplasty. With this technique, the orbital septum, the dangerous layer which attaches to the lower eyelid and-- if scarring develops-- can drag it down, causing a change in eye shape, is avoided altogether.

This type of cheeklift allows some skin to be removed from the lower eyelid with an extremely low chance of altering its shape.

The result is the preservation of an almond shaped eye with some tightening of the lower eyelid skin, plus tightening of the outer portion of the orbicularis muscle, reducing the appearance of below the lower eyelid wrinkles, including dynamic wrinkles. The eye-cheek junction is smoothened as well.

Some very fine doctors believe in augmentation of the cheeks as a method of enhancing cheek volume, and thereby filling in the lower eyelid-cheek junction, and this is something to discuss with your doctor as well, should the conversation come up.

But the simple answer is Botox.

Beverly Hills Plastic Surgeon
4.9 out of 5 stars 195 reviews

Botox and filler may be just the thing for you.

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Botox alone can be useful for dynamic rhytids of the lower eyelids.  Loss of fat in the tear trough/lower eyelid region can also make the wrinkles of the lower eyelids appear more prominent in which case you might also benefit from a small volume of filler (e.g. restylane).

Good luck.

Bryan K. Chen, MD
San Diego Dermatologist

Keep smiling

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Your lines are from a combination of smiling and sun exposure. Dynamic lines in the lower lid are impossible to eliminate completely and any treatment will not prevent recurrence as long as the muscles are being used for smiling and squinting. So if your goal is a slight softening of these lines, go ahead with Botox and possibly Restylane. But if you want no wrinkles, that can't be achieved and it would be best to save your money and just keep smiling.

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Botox, fillers or skin resurfacing

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Dynamic wrinkles are usually caused by muscle contraction. However, there is an underlying skin excess as well.

Botox works on relaxing the muscles and could help to eliminate some of these wrinkles that exist on the outside of the eye (crow feet)

As a general rule, I do not like to inject Botox too close to the lower lid or beyond the iris (color of the eye). Injecting Botox too close to the eyelid could weaken the muscle in this area (temporary).

A combination of Botox and skin resurfacing could address this problem.

Hisham Seify, MD, PhD, FACS
Orange County Plastic Surgeon
5.0 out of 5 stars 19 reviews

Botox Treatment for Crow's Feet and Undereye Wrinkles

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Botox cosmetic is effective in the treatment of dynamic wrinkles associated with overactivity of the orbicularis oculi muscle. In many cases, the lateral crow's feet are prominent as a result of soft tissue and skin atrophy, as well as overactive orbicularis muscles.

Rarely, the lower eyelid wrinkles can occur as a result of tissue discordance between the thick cheek skin and the thin eyelid skin. This results in wrinkling caused by the upward movement of the cheek while smiling. Botox is not useful in this situation.

Thus, it is advised to seek treatment with a board certified plastic surgeon to distinguish these two very specific situations and recommend the appropriate treatment.

Raffy Karamanoukian, MD, FACS
Los Angeles Plastic Surgeon
4.8 out of 5 stars 95 reviews

Dynamic Wrinkles=Botox

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For the dynamic portion of your lower eyelid, a small amount of concentrated botulinum toxin can be effective. As mentioned in previous post, botulinum toxin can deactivate a portion of the orbicularis oculi muscle. This muscle helps in providing tone to the lower eyelid. Your doctor should assess the strength and integrity of the lower eyelid prior to placement of botox toxin. A lid with poor tone can be pulled down with botox therapy creating a hounddog look aka ectropion. For other lines and contour changes of a static nature, there are other modalities which other posts have described.

Anil R. Shah, MD
Chicago Facial Plastic Surgeon
4.8 out of 5 stars 181 reviews

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.