Can Botox Be Injected Under the Eye?

Small amounts of dilute Botox can help diminish the fine wrinkles under the eye in select patients. It works best in younger patients that have good lid support and in carefully selected older patients that have favorable orbital anatomy. The main risk of lower eyelid treatment is that it can cause weakening of the muscles that support the lower eyelid. As a result, patients may experience "rounding" of the lower lid, which can make the eye look tired and aged. Unfortunately, not all Botox providers have the education required to be able to determine the ideal candidate for this treatment.   I do agree with the advice of your your dermatologist.  Botox will not correct eye wrinkles caused by upward movement of the cheeks when smiling. However, you may benefit from treatment with a traditional or fractionated-CO2 laser if your wrinkles are caused by significant inelasticity of the eyelid skin

Botox is effective to decrease the crinkles beneath the lower eyelid. It is best to treat the crows feet of the lateral eye at the same time to create a smooth effect throughout the orbit. It is best done by an experienced injector. As as you have noted, as you smile, your cheeks push the eyelids skin upward, and this is not cured by Botox.  What Botox will do, is to calm the Obicularis muscles, which makes the crinkles of the 'jelly roll' softer.   Most people like his effect. 

I often put a few units on the lateral (outside) portion of the lower lid. This is to help with these crinkles. Without photos and an exam it is hard to say for sure what your best treatment options are. I was going to suggest fractional laser, but I see you had that and feel it did not help. It is possible the settings were not strong enough. The settings are determined largely by your baseline skin tone. The more color you have the more careful we have to be.   Crinkles are very fine wrinkles and those are often best treated with laser. Possibly fat transfer could help also but you do not want fat in the actual lower lid so it depends exactly were the issue is located. Fat transfer does well for the lower lid bags and crinkles of he cheek lid junction.Hope this helps.Best of luck,DrC

The eye area needs significant combinations to get improvement. Lasers like erbium, co2, halo, profractional/contour, or Fraxel can all be used to build collagen long term. Plasma pen is a newer less invasive option but will take many treatments and require proper skincare. Plasma Pen is focused electrical plasma energy to tighten skin, producing small columns of energy just above the skin, allowing the skin to tighten to help improve wrinkles. This area will have 3-5 days of small “dots” that will then scab and peel, then the skin will tighter and brighter after. Numerous treatments are needed over lasers where only one or two give a bigger result, but more downtime. After plasma pen you NEED peels 2 weeks like later Cosmelan, enlighten or aerify, see emeragecosmetics (link). At home derma rolling should be started weekly even after plasma pen or lasers to further increase collagen, see emeragecosmetics AERIFY x anteagemd stem cell ampules. To properly heal you need light Stim red LED, EmerageSkin refit face, refit eye; AnteageMD serum, silagen silicone gel, jan Marini bioshield, EmerageSkin enzymatic polish, and EmerageSkin hyla b and AOX, and Sente dermal repair. Otherwise there is EXTREME risk of pigmentation issues and “dots” in the treatment area. at home peels like cosmelan, enlighten and aerify along with dermarolling (AERIFY emerageskin roller with Anteage MD ampules) should be started now regardless for antiaging, sun damage, and wrinkle prevention. There are many things you can do to treat under eye hollows and dark circles. A surgical option to remove skin and/or fat will such as eyelid blepharoplasty with or without fat pad repositioning (if doing lower eyelid surgery) will be the best long term. There are many things you can do to treat under eye hollows and dark circles without surgery. Non invasive less downtime options such as fillers, lasers, microneedling/PRP, cosmelan peels, and microneedling RF like Fractora, PiXel8 or morpheus can all help give some improvement. Accutite can often be used or stronger lasers like erbium or co2 spot treatment can tighten the skin and give very quick improvement in wrinkles and texture. I suggest you get a formal consultation to see what is best for you and your goals. Best, Dr. Emer.

Botox is not typically used under the eye, since it may actually make the wrinkles look worse if the muscle under loose skin is weakened. Of course, this can vary from patient to patient. If muscle activity is causing the lines, targeting that muscle with a bit of Botox could offer the desired effect. Other more common treatments for addressing the skin under the eyes are dermal filler placed in the tear trough and laser resurfacing.

You mentioned you did not see much improvement with Fraxel. I can understand this because a fractional laser like Fraxel usually requires a series of treatment sessions to produce an optimal outcome. There are other lasers I prefer to use in this area, such as a fully ablative CO2 laser, which really tightens that loose skin. I encourage you to schedule a consultation with an experienced, board-certified dermatologist with expertise in a broad range of skin treatments. With a thorough examination and treatment plan tailored to your precise needs and goals, you may see a better result.

This is not a common area to use Botox for a variety of reasons. While Botox is very effective in reducing the crow's feet that often fan out from the outer corner of the eye, using it directly under the eye can be risky and lead to less than stellar results. Other options for this area include small amounts of dermal filler, usually administered via a blunt-tipped cannula rather than a needle, or laser resurfacing. It's possible that the Fraxel treatment you had was not deep enough to produce the desired result or you might need a series of sessions to get the results you want. You can also go with a different type of laser that might be better suited to the level of correction you need. I encourage you to schedule a consultation with an experienced, board-certified facial plastic surgeon for further assessment and a customized treatment plan.

Yes but carefully.   Botox, by decreasing the enlarged muscles under the eye, sometimes called the "jelly roll" can open the eye aperture.  It is an amazing trick that can give and open eye appearance which looks great along with decreasing the crease under the eyelash margin.  Careful as it can worsen swelling under the eye if they pt has lost the muscle elasticity.  A simple snap test of the lower eye can tell you if they are a good candidate or not.  As a rule, younger patients are usually safe to treat this area. 
Another area on the lateral and lateral-inferior aspect is best treated with filler and botox. This is an extension of the crows feet under the lateral portion of the eye.  This is best treated with a blend of a thin filler and slight amount of botox, injected with a cannula to ensure even spread, break apart adhesions worsening the wrinkles and decrease bruising and pain. 

It can be used in the right situation. Having said that, I think the benefits are minimal and the risks can be significant. If I do treat this area with Botox, I usually only use 1 unit per side to avoid negative side effects such as loss of lower lid support.The foregoing information provided is not intended nor implied to be a substitute for professional medical advice, it is provided for educational purposes only. You assume full responsibility for how you choose to use this information. Always seek the advice of your physician or other qualified healthcare provider before starting any new treatment or discontinuing an existing treatment. Talk with your healthcare provider about any questions you may have regarding a medical condition.

Thank you for your question.  Placing botox under the eye is a possible solution for those fine wrinkles, however it should only be offered to select patients based on individual presentation. For some, administering botox to the under-eye area can cause laxity and an unpleasant, sagging result. In some cases, it is not warranted because the lines are being formed mainly from the cheek pushing upward upon smiling, and botox is not intended to stop this motion.  The dose for this area is very small, between 0.5 to 1.0 units, and best performed in conjunction with obicularis oculi injections for crows feet. Please seek an injector with experience with this specific treatment.  

In the appropriate candidate a trace amount of BOTOX Cosmetic can be injected below the eye to soften contraction of muscle that causes the “jelly roll” look under the eye.  Injection to this area is off label.  It is recommended to see your Board-Certified Plastic Surgeon for a consultation prior to treatment.   

You can use 1-2 units under the eye to soften those lines. If your injector doesn't feel comfortable performing the injection seek out an expert who has experience with advance techniques.