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

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.