Botox or Filler for Wrinkles Caused by Eczema?

Hi my name is Kirsten, I am 38 years old. I have suffered from eczema around the eyes most of my life and with constant use of steroid creams have been left with deep wrinkles and loss of elasticity around the eye area.

Would Botox or fillers help my skin around the eyes to soften the appearance of the wrinkles?

Doctor Answers 4

See a Dermatologist first

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My recommendation would be to seek a consultation with a dermatologist first. Do you have eczema on other areas of the body. If not, you might carry a different diagnosis.
It is possible that you have a chronic allergic contact dermatitis. Realize, that even if you do not wear eye makeup you might be allergic to something else such as nail polish, a moisturizer etc. The skin in the eye area is thin and delicate (the thinnest skin on the female is the eyelids; scrotum for a male) and can easily react causes a rash.

Chronic exposure may produce thickening of the skin and lines. Since steroids are discouraged around the eyes you might be well served with Elidel, a non-steroidal cream. Patch testing in which discs impregnated with various chemicals are placed on the back and read 48 hours later, may be helpful.

If you indeed have eczema and want this area treated there are a number of agents which can be used. Simple Aquaphor should help. Some of the under eye products such as Revale Replenishing Eye Therapy. This has every ingredient in it that I would recommend to treat the suborbital region (under eye area). Also, Teamine eye Complex and Replenix are good. Oil of Olay has an Age Defying Anti-Wrinkle Eye cream which has a Retinol in it. Retinols are much gentler and more tolerable than Retin A and Oil of Olay has a nice formulation.

I hope I have been of help, and good luck.

Virginia Beach Dermatologist

Injectables, Retin A may help

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Dear Kirsten,

Very difficult question to answer without a personal consultation. The steroids are known to cause thinning of skin and this can definitely contribute to fine lines. BOTOX is helpful for crows feet lines. It is generally less good on the eyelids themselves.

In the upper eyelid, the BOTOX could drift and result in unwanted ptosis or drooping of the upper eyelids. In the lower eyelid, BOTOX can soften lower eyelid wrinkles but can also weaken the orbicularis oculi muscle causing a sag in the lower eyelids.

Fillers, particularly Restylane®, can be threaded into the lower eyelid to provide volume, which can improve the lower eyelid wrinkles. However, this method is highly technique dependent so you need to go to someone who really knows how to get this done without making a bunch of lumps.

An alternative you might try is Retin A. This was originally approved for use in acne but it also thickens the epithelium. This thickening does improve fine lines for some individuals. The key is not to overdo the Retin A, which is quite irritating. No lines but lots of redness and flaky skin is not a good trade off. Using Retin A every 5th night is a good place to start. After two months, if there are no issues you can go up in frequency by a night (i.e. every 4th night).

If you develop redness and flaking, reduce the frequency by a night. Slowly increasing the frequency in this fashion allows the skin to adjust to the product and makes it more likely that you will have benefit with the product without creating too many side effects.

Kenneth D. Steinsapir, MD
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

Botox or filler for eczema-associated wrinkles

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If your eyelid eczema is still active, I would encourage you to seek help from a dermatologist to manage that problem first, as eyelid eczema itself can create the appearance of skin wrinkling. Botox and filler would not help with eyelid eczema. Botox is appropriate if you have wrinkles caused by muscle contraction around the eye area. Filler is appropriate if loss of fat tissue has occurred, leaving a "hollowing" under the eyelids.

Bryan K. Chen, MD
San Diego Dermatologist

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If your wrinkling is due to LSC, then Botox will not help. If not, then yes, it may.

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Thank you for your question.

So the answer to your question depends on the cause of the wrinkling. If the wrinkling is due to LSC (Lichen Simplex Chronicus), a condition secondary to chronic rubbing and scratching that leaves the skin thickened and wrinkled, then Botox will have a very minimal effect. However, people with eczema don't always have LSC, and they do age, so if there is a component of your lines that is due to aging and muscle use, then yes, Botox will lessen those effects.

It is crucial to fully determine the origin of the lines. Make sure that whoever you visit tells you the cause of your lines so that you know if the treatment is appropriate.

Good luck!

Don Mehrabi, MD
Beverly Hills Dermatologist

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.