I have what I consider to be severe smile related under eye creases and wrinkles; what are my best options to remedy? (photo)

You can see that my right eye is worse than my left. I also have bumpy crepe-like skin. This picture is about 8 weeks after Botox for my crow's feet.

Doctor Answers 7

Botox for undereye crease

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A small amount of Botox, usually 1 unit or less, injection into the orbicularis muscle right under the eyelashes on each side will help soften the "enlarged" muscle that is causing your eye crease which incidentally can become more prominent after Botox injection to the crow's feet. 

I consider this a slightly more advanced Botox treatment and so I recommend you go to someone who does it frequently. 

Botox under the eyes

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Based your photos, you have a band of "hypertrophic" or enlarged muscle. The muscle bulk can be reduced by injecting Botox into it, below the lash line on either side.This will improve the appearance of the crease that lies immediately below the hypertrophic muscle. Botox for the crow's feet creases does not improve it. If you have crepey wrinkles they can be improved with fractionated CO2 laser resurfacing. 

Renuka Diwan, MD
Cleveland Dermatologic Surgeon

Lower eyelid muscle hypertrophy and crepey eyelid skin

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Dear philoschic:

Your eyes are beautiful and deserve to shine! The Botox appears to have raised your lateral brow nicely framing your upper lids, lashes and blue colored eyes distinctively. 

While the lower eyelid muscle thickening does not bother me, it does bother you. Botox may thin or atrophy the muscle but then you are left with thin skin. Consider a lower eyelid blepharoplasty to properly frame the lower half of your eyes and achieve the look you want.

A caveat, lower eyelid surgery is performed by many but achieving the best results is performed by few. Please consult with a Board Certified Plastic Surgeon or Ophthalmologist who has the experience, skills and talent to evaluate and perform the correct procedure(s). 

All the best!

Dean P. Kane, MD, FACS
Baltimore Plastic Surgeon
4.9 out of 5 stars 100 reviews

Under eye creases

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Thank you for your question.ThermiTight and ThermiSmooth could really help diminish the appearance of these under eye wrinkles using radiofrequency heat. ThermiTight is microinvasive while ThermiSmooth is completely noninvasive.  Assymetry in wrinkles under the eyes is extremely common and is fixable. Your right eye would be treated a bit longer under radiofrequency heat. This procedure is completely safe and very effective. Please consult with a Thermi expert in your area to find out which procedure is best for you. Good luck!

Brian M. Kinney, MD, FACS
Los Angeles Plastic Surgeon
5.0 out of 5 stars 14 reviews

Did this exist prior to botox?

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Did you have the same appearance prior to botox?  If you did,  the best way to treat this would be with a lower lid blepharoplasty.  You have what is know as pretarsal fullness with muscle festoons.  Wow - that is a mouthful.  With a minor surgical procedure this can be improved, and possibly completely corrected.  See a surgeon board certified by the American Board of Plastic Surgery and get his/her recommendations.

Elliot Duboys, MD, FACS
Long Island Plastic Surgeon

Eye Wrinkles

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A combination of Belotero, Botox, and eMatrix will solve this problem.  Please consult an expert.  Best, Dr. Green

Microdroplet Botox May Help For Under Eye Muscle Hypertrophy & Crinkles

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Since your problem is aggravated by muscular movement and your photos suggest some hypertrophy (thickening) of the under eye muscles, you might be helped by the direct injection of a microdroplet or two of Botox placed into the belly of the muscles involved.

You would do well to discuss this with the physician who injected you. If he/she is not comfortable or familiar with this more advanced injection technique, then you might be wise to seek consultation with a board certified aesthetic physician with expertise and experience in the advanced uses of Botox (and other muscle relaxants).

Good luck to you

Nelson Lee Novick, MD
New York Dermatologic Surgeon
4.9 out of 5 stars 33 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.