Under Eye Wrinkles Caused By Smiling - Will Botox/Fillers Help?

Hi When i smile i get these horrible lines caused by my cheeks pushing up and causing a fold - they dissapear when i smile. How can i treat these? fillers/botox? anything?? i absolutely hate them and they are getting worse as i age. I am only 29. any advice would be fantastic thanks so much

Doctor Answers 20

Under eye fine lines

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The fine lines that you are complaining about are from loose skin. It is best to remove the skin conservatively to soften this.

Lower lid creases

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 You mentioned that the lower lid creases form when you smile and then you mention they go away when you smile, but you probably meant they go away when you stop smiling. There can be no guarantee but it's worth trying one to two units of Botox in the lower eyelid skin, just a couple of millimeters below the eyelash margin. the lid may change its shape and you may see some white of the eye below the iris.  lastly, if you have had preexisting puffiness in the eyelids, especially in the mornings when you wake up, then you shouldn't have Botox injected there as it will interfere with the muscular pump action and fluids may build up and  your swelling could look worse.

Ronald Shelton, MD
Manhattan Dermatologic Surgeon
4.9 out of 5 stars 38 reviews

Squinting and Smiling are two different things: like Yin and Yang

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You are very accurate and precise in your description. Yes these can be caused by contraction of the eyelid muscles which people do when smiling and this can be weakened with Boulinum Toxin. However this can cause more fullness of the lower eyelid by relaxing the muscles similar to relaxing your stomach muscles causes a fuller appearing belly.

However, you also push skin up to the eyelid when smiling with the zygomatic muscles and this cannot be weakened unless you want to look like you have had a stroke.

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Help for eyelid wrinkles

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Lower eyelid wrinkles can be reduced by proper placement of Botox or Dysport. In many people, Botox alone is sufficient.

However, the wrinkles come not only from muscle contraction, but also from loss of volume and decreased skin elasticity. Hydration of the delicate eyelid skin with an excellent moisturizer reduces wrinkles.

In many cases the loss of volume can be corrected with Restylane injections. Other patients may require a laser procedure to help improve the eyelid skin tone and texture.

Botox vs fillers under eyes

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Thank you for your question and for sharing your photo. Botox may help to soften the wrinkles under the eyes. It does require a very small amount and it will help to soften the lines. It will not necessarily reduce all the wrinkles like you might see in the forehead or crows feet region. You will notice a soft relaxation of the dynamic lines under the eyes, and you may notice a slight opening of the eyes. I would start with 1-2 units under the eyes on each side. If you like the effects, then it is very easy to incorporate this into your future treatments.

Dermal fillers such as Restylane can be used to fill in shadows under the eye and achieves a more rested look. You can combine the two treatments but it would require a thoughtful approach and careful analysis of your concerns to ensure that treatment options will help you achieve your goals.

I would recommend visiting with a board certified plastic surgeon or dermatologist in your area to address your concern as it is an advanced area to treat.

Smiles and wrinkles under your eyes may improve with a touch of botox...

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but the improvement is relatively slight...you only need 1-2 units of botox in 1 or possibly 2 sites...just a little bit under your lid margin...in some people a great benefit...most with some benefit...some especially in an older age group with weaker muscles...typically in the 50+ age group actually may be worsened...be conservative...a filler is typically not for this problem...but remember your skin will always crease somewhere when you smile...

Ken Landow, MD
Las Vegas Dermatologist

Botox of fillers for under the eyes

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  I think Botox might be beneficial here.  But I also agree that a conservative skin only lower eyelid surgery might provide lasting improvement.

Lawrence Kass, MD
Saint Petersburg Oculoplastic Surgeon
4.9 out of 5 stars 138 reviews

Botox for under eye creases~less can be best

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For the problem you're describing just a little bit of Botox properly placed in that lower eyelid area can make a big difference.  A slight bit of filler in the hollows under the eyes can also help to smooth the appearance.  And last but not least, don't under estimate proper hydration with a good eye cream in that area....dehydrated skin can bunch up and look horribly wrinkly.


Botox helps with lower lid lines

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Botox can soften lower lid lines. Your doctor should put emphasis on giving you a natural appearance. 

Robert Kasten, MD
Mainz Dermatologic Surgeon

Go with Botox

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Go with Botox. These are dynamic wrinkles (present with smiling and go away without smiling). This is the classic reason Botox helps. Do NOT use a filler (better for VOLUME loss issues). Make sure you go see either a Dermatologist or plastic surgeon, as this can be tricky area to inject.

Tracy Kuykendall, MD
Tulsa 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.