Will Botox Work for Lines Under the Eyes?

Question

I am not concerned with my crows feet as much as the lines that are under my eyes. They are deep even when I am not smiling, which is when they are the worst! Would Botox work for lines underneath my eyes?

David Hansen, MD · Answer

Botox only works half of the time for dynamic lines under the eyes, but when it works, it is very nice. Often fillers such a restylane, juvederm or diluted radiesse work well for the stationary lines under the eyes but should be done in 2-3 sessions and are combined with the botox to give optimum results.  
Botox $300; restylane or juvederm $550 / syringe; radiesse $630 per syringe.

Young R. Cho, MD, PhD · Answer

Thank you for your question and for sharing your photo. Botox may help to soften the wrinkles under the eyes. It does require a very small amount and it will help to soften the lines. It will not necessarily reduce all the wrinkles like you might see in the forehead or crows feet region. You will notice a soft relaxation of the dynamic lines under the eyes, and you may notice a slight opening of the eyes. I would start with 1-2 units under the eyes on each side. If you like the effects, then it is very easy to incorporate this into your future treatments. Dermal fillers such as Restylane can be used to fill in shadows under the eye and achieves a more rested look.  You can combine the two treatments but it would require a thoughtful approach and careful analysis of your concerns to ensure that treatment options will help you achieve your goals.I would recommend visiting with a board certified plastic surgeon or dermatologist in your area to address your concern as it is an advanced area to treat.

Darrick E. Antell, MD, FACS · Answer

I believe from your description that the lines under your eyes will be improved with Botox.
Dynamic lines, just like "crows feet" can be relaxed with Botox and you should discuss your goals with your plastic surgeon.

Richard Baxter, MD · Answer

As you know, Botox works by relaxing hyperactive muscles that cause wrinkles by repeatedly folding the skin. Crow's feet are an excellent example of this, but under eye lines are usually not. There are some people who have a hyperactive muscle just below the eyelashes, but this usually appears as a bulge rather than deep lines. I suspect that the lines you are seeing are caused by skin laxity and so would not be helped by Botox. An eyelid tuck (blepharoplasty) or a chemical or laser peel are the usual first lines of approach there.

Ron Shelton, MD · Answer

If the lines are present at rest, as in your situation, then Botox may not help that much, compared with resurfacing for photodamage-induced lines. This can be done by fractional Fraxel laser or chemical peels. Fillers may look lumpy in this area or may be visible because of the thin skin. Some patients who do have lines underneath the lower eyelids when smiling can obtain a nice result with very small units of Botox as long as there is no tendency for puffiness (the lack of muscle movement after Botox could minimize the draining of fluids and if one is prone to puffiness of the lower lids, then it could be compounded). Also, some patients have poor skin tone of the lower eyelid and the lid can be made to drop if Botox is injected there. That can create a dry feeling of the eye.

Robert Frank, MD · Answer

The other answers are all correct just a couple points:
1. I do think its worth a try with Botox to get rid of the most laterally located lower wrinkles...I definitely have patients for whom this has worked well. The more midline wrinkles aren't appropriate for Botox
2. I would do the Botox first before doing the filler. You may find you need less filler once the resting muscle tone is diminished by the Botox.
My two cents.

Otto Joseph Placik, MD · Answer

From your description namely, no wrinkles at rest, it is unlikely that botulinum toxin (Dysport, etc) will be of any benefit. It sounds as if your best option is fillers to fill the depression or surgical blepharoplasty to remove excess skin with or without staged resurfacing.

Nissan Pilest, MD · Answer

For the area beneath the eyes very little amount of Botox is needed.
If this, however, did not work for you, a Hyaluronic based filler such as Prevelle or Resylane may help those lines.
Finally, other procedures such as chemical peels or Fraxel CO2 repair may help if Botx and Fillers were not adequate.

David A. Robinson, MD · Answer

Botox may be beneficial to address wrinkles under the eyes depending on their severity.  Fines lines located on the lateral aspect under the eyelid tend to respond better than those in the middle.  
Sometimes the addition of a chemical peel will help smooth the wrinkles out more.  If your lines are deep while at rest or do not respond to these other methods, you may require treatment with a laser.
My advice is to start conservatively and work your way up to more aggressive, expensive treatments if needed.

Khaled El-Hoshy, MD · Answer

Botox would probably soften some of these lines, i.e. make them less deep & less in number. A very valid option is a chemical peel with 35% TCA or a phenol peel that is specially formulated for the thin eyelid skin.
Fractional laser may be another alternative. The trick is to be onservative so as not to end with "ectropion" with "show" of the white of the eye.

Will Botox Work for Lines Under the Eyes?

Answers (14)

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