How do I treat under eye wrinkles and cheek wrinkles? (Photo)

Question

Ive recently noticed (almost in a months time!)cheek lines and under eye wrinkles I've never had before. I feel like the under eye wrinkles appeared only after I treated my eye (crows feet) and forehead area with Botox. Could this be from Botox? I don't even see the Botox treating my crows feet as you can see. Will filler in my mid to upper cheeks make the multiple smile lines go away? Open to halo or fraxel as well. Thank you!!

Anna Chacon, MD, FAAD · Answer

It’s understandable to notice these changes after Botox and wonder whether the treatment itself caused them. From what you’re describing, it is certainly possible that the Botox changed the way the skin around your eyes moves when you smile, making lines in another area more noticeable. That does not necessarily mean that the Botox damaged your skin or permanently created new wrinkles.

The muscles around the eyes are interconnected, and when the orbicularis oculi is weakened with Botox, the way the lower eyelid and upper cheek move during smiling can change. In some patients, this can make a “shelf” or creasing at the lid-cheek junction more apparent, and temporary puffiness can also occur because muscle activity contributes to local lymphatic drainage.

I would therefore be careful about simply adding more Botox to the area. If the crow’s feet themselves haven't improved much, the issue may be the injection pattern, dose, or the fact that some of the lines are not purely dynamic wrinkles. Botox is most effective when the wrinkles are primarily caused by muscle contraction; it is less effective for fine lines that remain when the face is completely relaxed.

What about filler in the cheeks?

Potentially, but I wouldn't use filler simply to try to erase every smile line.

If there is some midface volume deficiency, carefully placed cheek filler can provide structural support and sometimes soften the transition between the lower eyelid and cheek. Cheek volume restoration is one of the established uses of HA fillers in facial rejuvenation.

However, filler will not necessarily eliminate multiple superficial wrinkles, particularly if those lines are primarily caused by skin quality, repeated smiling, or photodamage. Adding too much filler in an attempt to smooth every crease can actually make the face look heavier or puffy, which doesn't sound like the result you're looking for.

What about Halo or Fraxel?

This may actually be a more appropriate direction if the main problem is fine lines and skin texture rather than loss of volume.

Fractional laser resurfacing can improve fine wrinkles, texture, and photodamage by stimulating remodeling of the skin. The appropriate intensity depends on your skin type, degree of sun damage, and how much downtime you're willing to accept. Laser resurfacing and other energy-based treatments are among the nonsurgical options used for periorbital rhytides.

I would think of the treatments somewhat differently:

Botox: best for wrinkles primarily caused by muscle movement.
Filler: best when there is a true volume or structural deficiency.
Laser/energy treatment: better suited to fine lines, texture, and photodamage.
Skin care: important for maintaining the result and preventing further photoaging.

In your situation, I would first allow the Botox to fully settle and then reassess the face at rest and while smiling. If the new under-eye/cheek lines appeared after treatment, there may be a component of altered muscle movement that will improve as the Botox wears off, which typically occurs over several months.

I would also resist the temptation to chase every new line with another injection. Sometimes the best aesthetic result comes from doing less, not more, especially around the eyes. The goal should be to preserve your natural smile while improving the skin quality and overall transition between the lower eyelid and cheek.

Eric M. Joseph, MD · Answer

Additionally, we have found that injecting Botox to somebody's under eye creepy wrinkled skin may not help to improve this area. We have found however that Morpheus 8 treatments are very helpful for tightening thin skin around the eyes. I hope this helps! Sincerely, Dr Joseph

Nelson Lee Novick, MD · Answer

Regarding the parallel laugh lines on the lower cheeks, an appropriately injected, low viscosity, cohesive, HA filler can help to diminish their appearance with smiling. For the under-eye "jelly roll" crinkles, a couple of microdroplets of Botox may be helpful. As to why the prior Botox treatment did not work for the crow's feet, it is possible that too low a concentration was administered and/or too little injected, or the injections were not administered in the appropriate locations. As to RF and fraxel devices, you should note that these, as well as so many other expensive "bells and whistles" treatments, are backed far more by heavy marketing hype and social media buzz than hard science. So, you might wish to exercise a healthy amount of "buyer beware" before risking a whole lot of money and a whole lot of disappointment with any of these "here-today-gone-tomorrow" devices. I would not suggest that you go in asking for any particular device, since, to your later regret, you are likely to get exactly what you ask for.   You would be wise to make sure to consult with an experienced, board certified cosmetic dermatologist filler expert. Hope this helps and best of luck.

Camille Cash, MD · Answer

Botox and fillers can help soften dynamic wrinkles and provide volume.  Morpheus8 treatments can be used to improve overall skin tone and texture.  It combines RF technology with microneedling.  We also recommend using medical grade skin care products like Transform MD and wearing sunscreen every day.

Leonard Grossman, MD · Answer

The face ages on every single single individual through the process of loss of volume in terms of muscle and fat. This creates a deflation like effect. If you take a fully inflated balloon and try to squeeze it, there will be no folds whatsoever, and that is compared to a young face, on the other hand if you have a partially deflated balloon, and you squeeze it, there will be severe folding. In order to rejuvenate your face, I would not recommend the use of fillers, but instead consider fat grafting. When fat grafting is done by an expert in fat grafting techniques Plastic Surgeon, the results are extremely natural and practically permanent. I hope this helps and good luck from New York City Plastic Surgery .

How do I treat under eye wrinkles and cheek wrinkles? (Photo)

Answers (5)

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