Botox with Juvederm

I recently purchased a promotion of 20 units of botox & a syringe of juvederm from a plastic surgeon in chevy chase Md. I have moderate crows feet & they drive me insane. I have had botox in the past but was not satisfied with the results which is why I decided to try juvederm. What is the best to administer these to achieve the best result.

Doctor Answers 17

Botox or Juvederm for Crow's Feet

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The decision as to what to use to improve the lines around your eyes is best determined by a dermatologist or plastic surgeon, skilled not only in anatomy, but also in beauty and the aging process. In many cases, when Crow's feet are due to movement, Botox is a terrific option. In other cases, when there is too much laxity due to genetics, sun damage or smoking, a filler such as Juvederm or Restylane by themselves, or often in fact with Botox is a great option. In some cases, fractionated laser resurfacing is a nice option as well. Best to meet face to face with your doctor to discuss.

Toronto Dermatologic Surgeon

Botox with Juvederm

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I have used Botox for over 20 years adding the newer neurotoxins Dysport and Xeomin to reduce unwanted lines and wrinkles of the face and forehead.  IMHO, 20 units of Botox should give a very nice result in the Crow's Feet area.  Save the Juvederm for the lips, nasolabial folds for somewhere else.

Botox and /or Juvederm for cow's feet

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I don't think this is a Botox vs. Juvederm situation. If you have true crow's feet then the botox is what you need and the juvederm will not be the right choice(might need it elsewhere though). However, if these lines are from the pushing up of the cheeks with smiling ebotox will not do all that you would hope for. In this case, fillers might be able to change some of the way that the skin is draped on the face and might be helpful to some extent. However, this correction takes a lot of experience so make sure person has it and don't just grab a bargain. 

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Choose the right injector

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20 units of Botox really isn't a lot, but if you only want it in one area, like the crow's feet, it should be ok, considering you said they are "moderate". Injection of Juvederm around the eyes needs to be done by physicians with exceptional skill. Often improper injections leave a translucent coloring there, as well as bumps and ridges. It is not my syringe of choice for that area; Restylane would be, as it does not have these issues.

Botox and Juvederm for craw's feet

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Thank you for your question.

2 distinct group of the muscles play role in the development of the 'craw feet' wrinkles: periorbital (muscle encircling the eye orbit) and zygomatic ( the muscle which pushes up cheeks when we smile). In some people wrinkles will be due to effect of one or another group of these muscles, in others it will be combined action of these muscles causing skin creases.

Botox normally used to switch off periorbital muscle but not the zygomatic, so if your wrinkles mainly due to the action of the zygomatic muscle, then having Botox will make very little effect. To find out which group of the muscles are responsible for your craw feet wrinkles try to restrict the zygomatic muscle's action by holding your cheeks as if trying to stop  them to be pushed up. If you still get many lines around the eyes then probably your periorbital muscles mainly causing wrinkles. Botox in this instance very effective. If number of lines significantly reduced when the zygomatic muscle is restricted, then lines are mainly due to zygomatic action -Botox will not be very effective and using other methods like dermal filler, chemical peel or laser resurfacing will be more effective. I still would use a little dose of Botox trying to soften the lines and then use the filler, make sure more liquid form of Juvederm is used to avoid creating ridges due to over correction.

Botox is the number one treatment for crows feet

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Juvederm and Restylane are not great treatments for crows feet compared with botox. Juvederm sometimes creates more swelling than Restylane when close to the lower eyelids.  Some doctors use, as an off-label indication, the fillers as more of a scaffolding support underneath the entire cheekbone region extending around the eyelid on the side towards the temple, to reduce the fine lines without injecting each line and potentially creating a lumpy area in place of the fine crease.  bruising can be considerable in this area. If lumps occur, hyaluronidase enzyme may be needed to dissolve the filler. Botox usually produces such a great result for crows feet that fillers are not needed.  Fillers might be beneficial or laser resurfacing on the lines towards the cheekbones because botox there might weaken the smile muscles. Crows feet lines are related to muscle movement and therefore, botox is the best treatment as it relaxes the muscle and the overlying skin smoothens out.

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

Botox use for crow's feet

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Botox is helpful in relaxing the "O"-shaped muscle around your eye that contributes to crow's feet.  Volume loss and sun damage may also contribute to these changes around the eye.  Consulting with a skilled, board-certified dermatologist or plastic surgeon will offer the best treatment to address your eye area.

Melanie D. Palm, MD - Account Suspended
San Diego Dermatologic Surgeon

Botox and Juvederm for Crow's Feet

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As Dr. Lupo and Dr. Johnson stated, it depends on your anatomy.   An evaluation by a skilled injector can determine the most ideal treatment to meet your goals with the product you have.

Harold J. Kaplan, MD
Los Angeles Facial Plastic Surgeon
4.4 out of 5 stars 7 reviews

Treatment of Crows Feet

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With 'moderate" crows feet,Botox is the best treatment. Although I have placed Juvederm in deep creases around the eyes, it is rarely necessary. I'm sure the Juvederm can be used in adjacent facial areas.

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 40 reviews

Botox with Juvederm for Crow's feet

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Botox can provide great results to help smooth wrinkles around the eyes, such as Crow's feet. Patients can respond to Botox differently, but 20 units should be sufficient to help soften the area. Juvederm is typically not injected around the eyes for Crow's feet, but rather in areas around the mouth or lips. It's common to have combined procedures for enhanced results. Lastly, keep in mind non-surgical treatments typically can only do so much, so  cosmetic surgery might be more appropriate for your facial wrinkles.

Speak with your plastic surgeon regarding various options. Only after a comprehensive evaluation can he/she help determine appropriate options for you. Best of luck.

Dr. Chaboki


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.