Can Botox Be Injected Under the Eye?

I have crinkles under my eye.  My dermatologist and others refuse to put Botox under the eye.  The crinkles come when I smile, so I realize that it is my cheeks that are pushing into the eye area and cause the crinkles to form. One expert recommended fraxel which did nothing for the crinkles. I have heard that some doctors will put botox under the eye, is this possible?

Doctor Answers 116

Botox can be injected on the under eyes

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Thank you for your question.

It is possible to put Botox underneath the eye to help with those lines as well as the small bags that form under the eyes. A small bleb of botox (1-2 units) is placed in the area where the bags are. This should really only be done when the crow's feet are being treated wtih Botox at the same time, otherwise the effect will be minimal.

Keep in mind, that, the cheek muscles are strong and if you have bulbous or bigger cheeks, lines will continue to form underneath the eyes as that excess skin is displaced upwards as you smile. Also, bruising is definitely a possible side effect of injecting in this area. I think it's a small amount of Botox to try, so it's definitely worth a shot to see if it provides you with any benefit.

Beverly Hills Dermatologist

Is Botox Safe Under the Eye?

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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

Brock Ridenour, MD
Saint Louis Facial Plastic Surgeon
5.0 out of 5 stars 126 reviews

Botox Under the Eye works well for some patients

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Botox underneath the eye is an off label use of Botox, I use it often for patients who get the under eye "scrunch."  Their muscle is active there and 1-2 units of Botox can help smooth it out.  The low units don't last long, but they are effective.  I tell my patients it might be harder to squint and to make sure to wear sunglasses.  My patients are happy with this treatment. 

Rebecca Baxt, MD
Paramus Dermatologic Surgeon
4.8 out of 5 stars 29 reviews

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A tiny amount of Botox under the eye COULD be helpful, but is high risk.

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Your doctor may be correct in your situation, to avoid the Botox directly under the eye. It is very individual, and depends what the purpose of it is exactly. Remember that Botox does NOT smooth wrinkles. It only weakens underlying muscles. This may have the effect of smoothing a wrinkle, or it may have the effect of weakening the muscles that are important for blinking and closing your eyes safely. In addition, too much Botox around the lower lid can actually cause sagging and bagging. Be cautious.

Jessica J. Krant, MD, MPH
New York Dermatologic Surgeon
4.7 out of 5 stars 41 reviews

Not everyone will benefit from Botox under the eyes

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Botox works well for the thicker band of muscle that some people have, but if the lines form when you make a big smile, then I doubt you will see improvement from undereyelid placement of Botox. This is because you would have to have the Botox placed over the cheek bone, and this would possibly interfere with smiling, eating and speaking. You might look different from side to side, your corner of the lip lower on one side, etc.

Ronald Shelton, MD
Manhattan Dermatologic Surgeon
4.9 out of 5 stars 39 reviews

Botox can be injected under the eyes

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I do Botox injections under the eyes fairly routinely. The thing is that it must be used cautiously, and in small amounts only so that the lower eyelid function is not impaired.

Botox can be injected for Crow's feet but not under the eyes

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Botox cannot be used for the wrinkles under the eyes.  You can put Botox for the wrinkles on the sides of your eyes but not right underneath. If you place Botox there you will distort the natural look of your cheek and smile. This would be a very unnatural looking and unwanted side effect.  Fraxel will not help what you are describing either. It sounds like there is some excess skin which may need to be surgically treated one day. It is really important to find an experienced injector for the best results.

Yes, Botox injections under eyes is possible

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You can indeed put small amounts of Botox under the eyelid to smooth the lower lid.  Seek out a plastic surgeon or dermatologist who is skilled in this application. Good luck!

Under eye-great place for very small quantities of BOTOX

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Generally, when a doctor tells you that something can't be done, it means that it has not been successful in their hands. My father liked to say: "If the butcher tells you the meat's bad, you should listen."

The key with under eye Botox treatment is finding a clinician who is comfortable and experienced with this type of treatment. Don't make your doctor do a treatment they have told you they don't do well.

The lower eyelid orbicularis muscle makes those crinkling lines. This muscle is also responsible for holding the lower eyelid against the eye. The key is very small quantities of Botox to relax the muscle but not over weaken it, which causes sagging of the lid margin (not a good thing).

Also, the orbicularis muscle helps support the top of the cheek and in certain individuals prone to lower eyelid bags, this weakening can worsen the bag-also not a good thing.

For many individuals, they are better off having the lower eyelid filled with Restylane to redistribute the lower eyelid wrinkles.

Kenneth D. Steinsapir, MD
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

Botox in small amounts okay for undereye wrinkles

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Sure, Botox can be injected in small amounts into the wrinkles under the eye that occur with animation, or when you smile. Many people have these wrinkles that occur when the muscle called the orbicularis oculi contracts with laughing or smiling, and when they become noticeable or aesthetically bothersome, tiny amounts of Botox can be injected into the parts of the muscle of the lower lid that is hyperkinetic (or moving a lot to cause the wrinkles).

I would recommend speaking to a dermatologist or plastic surgeon who has a great deal of experience with Botox injections for this procedure, as it shouldn't be overdone or you may get problems with forceful shutting of the eyelids and other problems related to the muscle. Fraxel would be OK for fine superficial skin wrinkles that are present whether or not you are smiling or laughing.

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.