Why Does Botox Treatment for Crows Feet Make Dents in my Cheeks, Wrinkles Worse and Bags Under my Eyes?

For the last couple of botox treatments (by 2 different docs) my wrinkles are worse when treating my crow's feet. I also have flattened cheeks and bags under my eyes. I had this treatment years ago and the doctor who did it only injected near my temples and it was only one shot on each side of my eyes. It worked great! So could it be the injection placement? Should I go back to injecting the temple area? And why would that work better than the 3 injections around my eyes that the other docs did?

Doctor Answers 7

Botox flattening cheeks

A picture would be of benefit but your descrition makes me suspicious that you had too much Botox used on the entire muscular unit that surrounds the eye.  The orbicularis muscle is like a sphincter and if is over relaxed, the entire subunit around the eye can sag, look flat and lifeless.  Botox can even drift further down the face and can impact the muscles that are part of the smile.  Time to back off the total amount of Botox used around the eyes in the future.

Los Gatos Dermatologic Surgeon
5.0 out of 5 stars 11 reviews

Don't like results from Botox to Crow's Feet

First, I agree with Dr. Baxter's answer about placement and proper injecting. And second, I will add that you said you were treated "years ago". Remember, then that some additional aging and changes in your facial shape has happened, so the treatment won't produce the exact same results over time. You may need to consider some alternate procedures if you have flattened cheeks and bags under your eyes, as relaxing the muscles near it now, may not be producing the results you want.

F. Victor Rueckl, MD
Las Vegas Dermatologist
4.6 out of 5 stars 17 reviews

Botox and crow's feet

If you had a better post procedure cosmetic outcome with the first provider, return to that provider for repeat injections. You also seem to know that if he/she stayed on the outside of the orbit (temple), the outcome was more pleasing to you ... so, again, have them inject that area only as they can always add more Botox a week later if you don;'t get the effect you desire. It is always important to post pictures so that we better understand your concerns.

Hratch Karamanoukian, MD, FACS
Buffalo Phlebologist
4.8 out of 5 stars 41 reviews

Bags under the eyes and flattened cheeks following botox treatment

It is difficult to see what you are referring to without seeing photos. A poor result could be related to amount injected, placement of the injections, and poor technique. I would recommend visiting your provider and communicating this concern to him or her. I hope this helps, and I wish you the best of luck.

Paul S. Nassif, MD
Beverly Hills Facial Plastic Surgeon
4.7 out of 5 stars 47 reviews


A picture would help in understanding what you are trying to describe.  It would  also help to know how many units were injected.  It sounds like perhaps too much botox was used.

Asif Pirani, MD, FRCS(C)
Toronto Plastic Surgeon
5.0 out of 5 stars 35 reviews

Botox and worsening lines

It is very difficult to answer your question without first knowing the details-how many units were used and actual placement? Also, you should consider posting photo's minimally for better assessment.

Sam Naficy, MD, FACS
Seattle Facial Plastic Surgeon
4.7 out of 5 stars 221 reviews

Fine tuning Botox for balanced results

Because Botox works by relaxing hyperactive muscles of expression, it can alter the balance of facial features. For example, brow position is affected by muscles that lift and muscles that pull down, such as the ones that cause crow's feet. Similarly, the crow's feet muscle (called the orbicularis) lifts the upper cheek area, so relaxing it can weaken support for the lower eyelid area in some cases. Based on the response, an experienced injector should be able to alter the technique the next time with different placement and dosing to minimize the problem.

Richard Baxter, MD
Seattle Plastic Surgeon
4.9 out of 5 stars 52 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.