Why Have Botox Injections Not Significantly Reduced my Crow's Feet? (photo)

It's not uncommon for the crow's feet/lines to return sooner than you might expect. Occasionally, not waiting the recommended time between treatments can result in some resistance. The skin itself gets more lax with aging, and there are other treatment/options for skin tightening, along with Botox.

For most cases of crow's feet related to movement, the use of neuromodulators, such as Botox, Dysport and Xeomin are effective. I have found that a more effective and inclusive approach involves the use of both neuromodulators and treatment directed to the static wrinkles that inevitably result from years of continued folding of the skin with facial movement. For this purpose I have found The Nonsurgical 3D Vectoring Facelift to be especially useful when combined with neuromodulator treatment.

Using the principles of vectoring with volumizing fillers (see The Nonsurgical 3D Vectoring Facelift, The 3D Vectoring Necklift, and the The 3D Vectoring Browlift for further explanation), the region over the bone within the fixed (nonmobile) area of the cheek directly in front of the ear is used as an access point to instill "strands," "strains," or threadlike amounts of the volumizer in a fan shape distribution over the mobile crow's feet (periorbital) area and extending onto the cheek. Requiring only a tiny amount of local anesthesia to numb the entry points, the procedure is relatively painless and takes only a few minutes on each side to perform.

As a rule, immediate smoothing of the crow's feet area is seen. However, as with the other Nonsurgical 3D Vectoring Lifts, continued improvement is anticipated over the next six to eight weeks as new collagen. Treating both the motion and static components of the problem tends to prolong the results of therapy beyond that which might be obtained with either therapy alone.

I agree with the other doctors that these lines do not actually appear to be crow’s feet, by definition. It looks like a separate muscle contraction is causing these lines. In any case, I’ve had routine Botox patients report that the product’s effectiveness decreased over time. One of them recently switched to Belotero to treat his crow’s feet and he is very happy with the results. Perhaps you should try this filler next time in lieu of Botox. Additionally, your situation can be improved also by the use of resurfacing lasers such as Fraxel repair.

21 units per side is a rather high dose for crow's feet (Assuming FDA approved American product that has been correctly reconstituted and the toxin is active) and should last 3-4 months.  The result will also depend of the depth and nature of the crow's feet.  Sometimes neuromodulators can work synergistically with laser resurfacing to obtain a complete result.  Consider trying Xeomin or Dysport in the future.

very occasionally botox denatures when hydrated in suspension rendering the solution ineffective. Have you doc check the batch number and see. Also I have found occasionally a treatment will not work in previous good responders  - no idea why! - a top up usually suffices.