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

Hi, I'm 33 and have fine lines from underneath my eye down my cheek bone when I smile. I got botox injections done May 1, 2014. It's been 3 weeks and when I smile the lines are there. Unfortunately I didn't take the before photo, attached is the picture I took today. I am not sure if botox helped me or didn't do anything. I was hopeful that when I smile that part of my face will not wrinkle anymore. I would really appreciate your expertise. (The doctor that did it moved away, I can't go back)

Doctor Answers 7

Botox around the Eyes

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. 

New York Dermatologist
5.0 out of 5 stars 78 reviews

You don't want to paralyze your cheek with Botox, that is not the right treatment

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

Anne Marie McNeill, MD, PhD
Newport Beach Dermatologic Surgeon
5.0 out of 5 stars 1 review

Improving under-eye wrinkles

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.

Karen Stolman, MD
Sandy Dermatologic Surgeon
5.0 out of 5 stars 7 reviews


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.

Philip J. Miller, MD, FACS
New York Facial Plastic Surgeon
4.7 out of 5 stars 83 reviews

Fine lines under eyes

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.

Nicole Kafka, MD
New York General Surgeon
1.0 out of 5 stars 1 review

Fine lines around eye and down cheekbone

Botox works exceptionally well for the smile lines.  What I am seeing in your picture, are fine
lines without smiling and sun damage.  For your situation, I feel an IPL Photofacial would work,
which eliminates broken blood vessels, fine lines and wrinkles, eliminates age spots and lets
your skin shine naturally.  Even though you are young, you need to begin using a good sunblock
on your face and wearing a hat for shade.  Get with a reputable Medspa near you for your IPL.

Charles A. Wallace, MD
Dallas Plastic Surgeon
4.2 out of 5 stars 6 reviews

May need more Botox

Your before pictures and information about the area of injection and # of units would have been helpful. You may need more Botox.

Kamran Khoobehi, MD
New Orleans Plastic Surgeon
4.7 out of 5 stars 124 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.