Horrible lines post Botox. What is this? (photo)

Question

I have had Botox done 2-3 times a year for the past decade. About 6 years ago, I noticed pronounced lines under my eyes. Now everytime I have Botox done I get them. No one has been able to tell me why. One professional told me it’s swelling. But it isn’t, it’s the muscle and it’s worse when I smile. What is this? And how do I treat?

Ella Fedonenko, MD · Answer

When you receive Botox for Crows feet area the muscles under your eyes sometimes overcompensate(overcontract) and cause the kind of lines you are seeing. One option would be to decrease number of units you use for Crows feet area. Another option would be to inject 2-3 units of Botox in your under eyes area simultaneously with your Crows feet area injections.

Lexie Wang, MD · Answer

One critical piece of info you're missing is where have you been getting botox injected. My guess is based off what you said that they've been doing crow's feet. This will naturally weaken the orbic musccle out there but might not weaken and may infact cause it to be stronger medially (closer to the nose). Have you tried gettring botox closer to the  nose?

Another thing is simple aging. OUr eyelid skin is the thinnest most fragile vulnerable skin in the body. That means aging will show here first. Skin crinkling/crepeyness/laxity is a common symptom of this. Consulting with an aesthetician could do wonders for this area as well as coming up wiht a plan for the face longterm as it ages

Eric M. Joseph, MD · Answer

We inject somebody's crow's feet with botox, we advise them that the crepey wrinkled skin underneath the eye may in fact get worse. Additionally, we have tried to soften these wrinkles under the lower lash line with botox, and we have not been successful. In fact, it is an area easily bruised. I hope this helps. Sincerely, Dr Joseph

Rajaie Hazboun, MD, MBA · Answer

Thank you for posting your question here !My answer will be based on the limited information and pictures provided, for a detailed and personalized plan please consult with your plastic surgeon in person.
There are multiple reasons for those lines appearing chief amongst them would be muscle compensation , when you inject botox in a certain muscle or part of a muscle that area might get paralyzed but other muscles or the not paralyzed areas of the muscle injected will try to compensate for the loss of function causing wrinkles.the other most likely possibility is facial aging , loss of skin elasticity and volume.I hope this helps, best of luck!

Zoran Potparic, MD · Answer

Every time when we smile the entire skin of the face is moved up and laterally; as a result there is increased wrinkling around the eyes even when a baby smiles. In your case increased creases may be more result of periorbital aging and volume loss. In person consultation with a board certified plastic surgeon with good reputation in facial rejuvenation is recommended. You may be a candidate for blepharoplasty (eyelid surgery) and possibly periorbital fat grafting. Hope this helps. Good luck.

Anna Chacon, MD, FAAD · Answer

The appearance of pronounced lines under your eyes following Botox treatments is a concern that some patients experience. Here are a few possibilities and potential solutions:

Cause of Lines:

Muscle Compensation: Botox relaxes specific muscles, and sometimes other muscles may compensate, leading to the appearance of lines or wrinkles in other areas. This could be what's happening under your eyes.
Skin Laxity: Over time, skin can naturally lose elasticity, and the absence of muscle activity due to Botox might make these lines more noticeable.
Volume Loss: Aging can lead to a loss of volume under the eyes, which might be accentuated after Botox as the surrounding muscles relax.
Treatment Options:

Topical Treatments: Use retinoids or creams with peptides to help improve skin texture and elasticity.
Microneedling or Laser Therapy: These treatments can stimulate collagen production and improve the appearance of fine lines and skin texture.
Radiofrequency or Ultrasound Therapy: Non-invasive procedures that can tighten the skin and reduce the appearance of lines.
Consultation with a Specialist: A dermatologist or cosmetic surgeon can assess your specific situation and recommend personalized treatment options, possibly adjusting the Botox technique or exploring other areas to target.
Prevention Tips:

Adjust Botox Technique: Discuss with your provider the possibility of altering the injection sites or doses to minimize unintended effects.
Regular Skin Care: Maintain a consistent skincare regimen that includes hydration and sun protection to support overall skin health.
It's important to have a detailed discussion with a qualified professional who can evaluate your individual case and provide tailored advice.

Stefan Weiss, MD · Answer

It would depend on where the botox was being administered. You are getting asymmetrical muscle movements as compensation for the muscles that are totally or partially relaxed. I would take a step wise approach to the relaxation of individual facial muscles until the corrections was identified.

Camille Cash, MD · Answer

An in person evaluation is best but this is likely skin laxity due to age and volume loss.  Botox will not improve it and could make it appear worse depending on where the product is injected.  I encourage you to speak with an experienced injector to discuss your concerns.

Horrible lines post Botox. What is this? (photo)

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Answers (8)

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