Wrinkles under eyes - would more Botox help or should I try a filler like Sculptra?

I'm starting to get fine lines and little wrinkles underneath my eyes. I've been having Botox for a few years to treat my crows feet and the results are very subtle in fact not that great to be honest. I refrain from having too many units for fear of looking frozen. Would more Botox help or should I try a filler like Sculptura?

Doctor Answers 11

Treatment of wrinkles under the eyes

Wrinkling under the eyes can be a complicated condition to treat.  Fillers, Botulinum toxins,surgery and laser resurfacing can all play a role.  I would strongly suggest consultation with an expert in rejuvenation of this area.


Nashville Oculoplastic Surgeon
4.8 out of 5 stars 41 reviews

Wrinkles under your eyes

Botox helps extremely well for wrinkles around the eyes (the Crow's feet). I would not suggest Sculptra under the eyes since it would be the wrong product.  There is no photo but from your description it sounds like a filler like Belotero would help under the eyes by filling in these lines.  Please consult a board certified dermatologist with a great deal of experience in the delicate area under the eyes for the best cosmetic results.

Michele S. Green, MD
New York Dermatologist
5.0 out of 5 stars 71 reviews

Botox and Sculptra

Botox and Sculptra complement one another. Botox can improve dynamic wrinkles and Sculptra is ideal to build collagen in the eyelid-cheek junction.

Best,

Dr. Karamanoukian

Raffy Karamanoukian, MD, FACS
Los Angeles Plastic Surgeon
4.8 out of 5 stars 94 reviews

Under eye Wrinkle options

Dear Merlin0704:

It is best to be evaluated directly by a well experienced and Board Certified Plastic Surgeon, Facial ENT or Dermatologist for wrinkles around the eyes.

Botox relaxes the muscles that pull on the skin to create wrinkles. Occasionally and in particular when injected for the radiating lines below the horizontal of the outer eyes and for the creasing of the lower eyelid, side-effects such as swelling or bulging of the eyelid fat pads, lower lid rounding and cheek sag. Botox would therefore not be my first choice in this area.

Consider a skin tightener such as retinol / Retin-A, TCA peels or laser depending on the thinness and pigmentation of the skin.

Another option in very skilled hands is the use of Sculptra. For my patients, the results are wonderful and exampled below.

Traditional hyaluronic acid (HA) gel fillers may cause side-effects such as swelling or a bluish tinting BUT the recent introduction of Restylane Silk maybe your best bet.

Silk, due to its very tiny particle size and hydration properties will smoothen fine wrinkles and lines. It is on-label around the mouth and lipstick lines and proving very useful around the eyes for crows feet and wrinkle lines as well. 

I hope this has been helpful. All the best!

Dean P. Kane, MD, FACS
Baltimore Plastic Surgeon
4.9 out of 5 stars 79 reviews

Botox for fine lines

Botox is an effective treatment for crow's feet and can be helpful just under the eyes in some patients.  Sculptra is not a filler and should not be used around the eyes since nodules can develop.  An experienced dermatologist or plastic surgeon can determine if you require more Botox or a hyaluronic acid filler such as Restylane Silk.

Martie Gidon, MD, FRCPC
Toronto Dermatologist
5.0 out of 5 stars 22 reviews

Wrinkles under eyes and Botox not helping

Botox can help with lines around the eyes but it does tend to work best on the lines beside the eyes and not under them.  Fillers sometimes can help with lines under the eyes, but not in everyone.  I would not recommend using Sculptra under the eyes because it is possible to develop visible bumps there.  If you were to have a filler under the eyes, I would use one of the hyaluronic acid fillers.  It is also possible that a different treatment, like a chemical peel or laser resurfacing could help with lines under the eyes.  Additionally, sometimes surgery can be done to improve the same issue.  

Michael I. Echavez, MD
San Francisco Facial Plastic Surgeon
4.5 out of 5 stars 18 reviews

It would all depend on your facial anatomy.

Botox and fillers are used in combination to solve different problems.  If you have facial wrinkles that bother you and do not want the lines to form at rest or become more obvious, then Botox is the answer.  If your lower eyelids become more prominent with fat bulging out and you are losing volume in your cheek, then Sculptra would help to improve volume in the cheeks and reduce the noticeability of the more prominent lower eyelids.  I would advise you to see a board certified plastic surgeon for a comprehensive analysis and treatment options.  The best thing to do is to become more knowledgeable about these products so that you can make good choices for yourself.  Not every doctor knows how to use these products well.  Good luck!

Tae Ho Kim, MD
New York Plastic Surgeon
5.0 out of 5 stars 10 reviews

Wrinkles under eyes

For the delicate under eye skin, Fraxel® laser (a mild resurfacing laser) is the gold standard for erasing small under eye lines and wrinkles in patients of all ages and skin types.

Manjula Jegasothy, MD
Miami Dermatologist
5.0 out of 5 stars 8 reviews

Do not use Sculptra under eyes

While I am a strong proponent of Sculpta for the cheeks,  I strongly discourage its use in the areas around the eyes. Yes, there are some individuals who have experienced a good result, should there be an issue this area on account of its delicate nature if far less forgiving.  The concern is with nodule formation, and in this region they are more difficult to conceal.  Onset can be delayed and they can persist for a long time, and surgery can be necessary to remove the material.  Consult an facial plastic surgery expert before embarking on this treatment. There are many excellent alternatives.

Arthur N. Falk, MD
Albany Facial Plastic Surgeon
4.6 out of 5 stars 10 reviews

Botox or Sculptra for under eye wrinkles

Botox as a neurotoxin is very successful for softening wrinkles around the eyes by relaxing the orbicularis muscle. However, as we age, there are multiple reasons for the wrinkles. Volume loss is usually a significant portion as well as changes to the skin. It is difficult to say whether a filler such as Restylane or Juvederm would be better or Sculptra. Sculptra is terrific as far as improving skin tone and texture and also lifting and shaping the face. It should only be used around the eye area by an advanced injector with experience treating wrinkles around the eyes. It is not a traditional filler but rather a collagen stimulator so usually a few treatments are necessary for the best results. Seek out an Oculoplastic surgeon with experience in Sculptra as well as the other fillers and they should be able to lead you in the right direction. I hope that’s helpful. Best of luck!

Joseph A. Eviatar, MD, FACS
New York Oculoplastic Surgeon
4.7 out of 5 stars 66 reviews

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.