Botox injections for fine lines under the eye going down the cheek bone. Why did it not work? (Photo)

Botox is a wonderful product and great for parts of the face where the lines are caused from muscle movement like the forehead and the crows feet. Botox works by freezing the dynamic action of the muscle so that it cannot make the movement that causes the wrinkle. Static lines are harder to treat with Botox because they happen from things as basic as sleeping on the same side of your face for years. These static lines do not respond as well to Botox, but there are other great options for you to consider such as laser resurfacing and fillers. It is hard to say how much improvement you saw since I cannot see your before photos, but at 3 weeks out, it probably is not going to improve anymore than it already is with just Botox.

Botox works extremely well for the Crow's feet which are the lines around the eyes.  It can not be used for lines that go down to your cheek since that would paralyze the sides of your face. 

Lines going down to the cheek are not best treated with Botox.   If that area is "paralyzed" by Botox, you would not be able to smile.  Botox is used for the creases to the sides of the eyes, but not on the cheek.The lines on the cheek would be best addressed by revolumizing your cheek with some filler in your cheek/temple area (such as Voluma or Restylane), along with fractionated resurfacing such as fractionated CO2.. Best, Dr McNeill

I see that you are just beginning to develop some under-eye wrinkles.  I find that Botox does not work so well for those wrinkles without carrying the risk of sinking down to the cheek muscles and interfering with cheek expression.  In other words, to avoid that risk, we put less in the under-eye which tends to not work so well in many people as far as smoothing the wrinkles.  I find filler to also be problematic in that area because of the Tyndall (blue discoloration) effect, and even with Belotero which is less likely to give Tyndall, it is so thin the results are short-lived.  Instead, my preferred approach to treat mild to moderate under-eye wrinkles is radiofrequency tightening with either Invasix or Endymed.  Another option is EMatrix fractionated RF.  These treatments require multiple treatments, 3-6, but offer good, lasting results with very little to no downtime.

It is difficult to assess your situation well from the photo. From your description, these lines are not "crow's feet," which are treated well with Botox, but lower. If this is true, the anatomy is not a great target for Botox. You would do better with a treatment approach addressing skin texture and tone such as chemical peels, photofacials, or radio frequency skin tightening. A good regimen of skin care products for daily use would also be helpful.