3 months after Botox in the crows feet - what can I do to minimize the appearance of wrinkles in the under eye area? (photos)

Question

It has been three months and I have waited for these wrinkles in bags under my eyes to go away. I never had them before until I got Botox in my crows feet. I believe I either had nine or 12 units on each side and the wrinkles are not going away. What can I do to get rid of them? Is it possible that I was over injected and will this reverse?

Randal Haworth, MD, FACS · Answer

It's possible that the wrinkles and bags under your eyes are related to the Botox injection in your crows feet. Botox works by relaxing the muscles that cause wrinkles, but in some cases, it can also affect the muscles around the eyes and cause changes in the appearance of the skin.

If you are concerned about the appearance of your under-eye area, you should schedule an appointment with your injector or a board-certified dermatologist or plastic surgeon who has experience with injectable treatments. They can assess your skin and determine the best course of action.

If the wrinkles and bags under your eyes are related to the Botox injection, the effects should wear off within a few months. However, it's possible that you were over-injected or that the Botox was placed in the wrong area, which could cause the effects to last longer.

To address the wrinkles and bags under your eyes, your injector or doctor may recommend additional Botox injections in different areas, dermal fillers to plump up the skin, or other non-surgical treatments such as laser resurfacing or chemical peels. In some cases, surgery may be necessary to remove excess skin or fat in the under-eye area.

It's essential to choose a qualified and experienced injector or doctor for any cosmetic procedure, including Botox injections. They can help you understand the potential risks and benefits of the treatment and determine the best approach for your individual needs and goals.

Best of luck !

Jonathan Kulbersh, MD · Answer

Thank you for your question and photos. You may benefit from a combination of lower blepharoplasty and laser resurfacing to rejuvenate the skin under your eyes. Lower blepharoplasty is ideal for removing excess skin, tightening the remaining skin, and repositioning fat to achieve a smooth transition from the lower eyelid and upper cheek. This surgery can be combined with laser resurfacing to treat fine lines and reduce their appearance. 
I recommend scheduling an in-person consultation with an experienced, board-certified facial plastic surgeon or expert injector. They will be able to review your treatment history and evaluate your concerns to determine the best way to help you achieve your aesthetic goals.

Anil R. Shah, MD · Answer

Hello,

If you did not have bags before the Botox injection, it could be possible that you were over injected. When your muscles move they pump fluid out of the area. If we relax the muscles under the eye the muscle pump doesn’t work effectively. This can cause fluid retention or Periorbital edema, which is self limiting. Using hot compresses can help Venous return and aid in minimizing the edema.

Jason Emer, MD · Answer

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.

Camille Cash, MD · Answer

Botox effects gradually fade over three to four months.  There is no reversal agent for Botox.  If you do not see improvement of the under eye area you can consider filler and/or Morpheus8.  This treatment works to improve overall skin tone and texture.

Douglas Taranow, DO, FACOS · Answer

Wrinkles may appear under your eyes post crows feet injection due to the paralyzing effects of the lateral muscles.  If this is the cause, then adding very few units of Botox just under the eyes will reduce this.  If the new folds are related to normal fat pads, then the Botox will not have any effect.

Leonard Grossman, MD · Answer

There are many reasons why an individual can have wrinkles. In your case, it is the fact that as the person ages, with loss of volume in the lower eyelid area, as well as the cheek. Just like a balloon, when deflated becomes kind of wrinkly, the same thing happens to your face. The best, and the only way that I can recommend you should treat this problem is with the addition of autologous fat, which means adding some of your own fat from somewhere on the body, and have that fat injected in to the lower eyelid and the cheek area. This procedure will restore the volume And make you look younger than ever. When done by a plastic surgeon with lots of experience in fat grafting techniques, the results are extremely natural and permanent. I hope this helps and good luck from New York City Plastic Surgery.

Brooke R. Seckel, MD, FACS (retired) · Answer

Thank you for your question.  Botox injections can only correct crows feet on the lateral or outside portion of the skin around your eyelids.  Botox cannot be injected medially towards the nose for it because the lid to become lax and possibly allow the cornea to be exposed.

Based on your photographs the Botox has been effective in removing the crows feet using currently accepted technique.

What you are seeing are areas where the Botox was not injected, should not be injected and the wrinkles cannot be corrected there.

What you see is loose skin and correction of what you are seeing would require a surgical technique: Lower blepharoplasty.

3 months after Botox in the crows feet - what can I do to minimize the appearance of wrinkles in the under eye area? (photos)

Answers (8)

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