Crow's Feet Not Completely Gone Post-Botox

I had Botox a week ago for my crow's feet around the eyes. However, not all the wrinkles are smoothened out, I see three lines on the corner of each eye, looks like a cat's whisker. Why weren't these lines completely smoothened out by Botox?

Doctor Answers 15

Unrealistic Expectations from Botox

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Everyone has to have realistic expectations from Botox.  Botox truly is a wonderful treatment and is very effective with very few side effects.  However, there is a balance between smoothing wrinkles and maintaining function in your expressions.  Sure, so much Botox could be injected that you do not move your face at all - but you would look like you had a stroke.  I am sure that is not what you are looking for.  Also, Botox works by temporarily paralyzing the underlying muscle to relieve stress on the overlying skin.  This relaxes the wrinkles from dynamic action from the muscles.  If you have static wrinkles - wrinkles that are there at rest - Botox may not be completely effective the first time you have it.  It is important that you discuss your expectations with your surgeon before having treatment to make sure they are realistic.  Good luck.

Botox in the Crow's Feet Area

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It might simply be that not enough Botox was placed to effectively control the muscle movement in the crow's feet area. You also may need to have Botox placed below the corner of the eye into the high cheek zone to stop this portion of the muscle from moving. If a sufficient amount of Botox was already placed and the distribution area was correct, you might need to consider a skin resurfacing procedure to provide further improvements.

John M. Hilinski, MD
San Diego Facial Plastic Surgeon
4.7 out of 5 stars 44 reviews

Botox and Crow's Feet

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Botox does not remove all the lines. There are many muscles on your face that trigger different facial expressions. Botox is effective in removing lines from one source or muscle. You may be seeing lines forming from another muscle that has not been relaxed by Botox. Also, botox can take up to 2wks for final effect. If after two weeks you still have concerns, discuss them with your doctor. At times you may require a touch-up.

Bahram Ghaderi, MD
Chicago Plastic Surgeon

Botox Adjustment Not Unusual

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It takes 4-7 days for the full effects of a Botox injection to appear and Botox is a dose dependant treatment.  This means that to achieve similar results, patients require varying amounts of Botox...some more, some less.  To get full correction, it's not unusual to have an adjustment or added Botox within the first month after the initial Botox treatment.

Botox is not an immediate wrinkle releaser.

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It's not a total surprise that after Botox for crow's feet next to your eyes, you might still see a few fine lines persist, especially if this was your first time getting treated. Botox works by relaxing or preventing muscle contraction. The line smoothing is a secondary side effect. Understanding this helps you understand why it's important to continue regular follow up for Botox treatments to keep the area from re-crinkling, because it's over time that the lines will naturally smooth, when they aren't creased on a daily basis.

If you only do Botox once in a while, you can't expect long term smoothing, since any gain is lost by the re-creasing in the months following.

Ways to Enhance Botox For Crow's Feet

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Botox work on muscular related wrinkles, or movement wrinkles.  Static wrinkles, the ones you have at rest, do not respond as much.  As such, there are several ways to improve the results of botox for crow's feet:

1.  first, botox the area

2.  then, after waiting the effect of botox takes place, consider one of the following:

a.  chemical resurfacing

b.  laser resurfacing with either fractionated laser or subablative fractioned laser resurfacing.

c.  low density hyaluronic acid filler

d. platelet rich plasma

e. combinations of the above

George Sun, MD
Los Angeles Facial Plastic Surgeon

Incomplete result after Botox for crows feet

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Botox is a very effective and powerful medication. We commonly use it to help erase wrinkles in the upper face that are caused by muscle action. Every patient is different and has a different amount in concentration of muscle. For patients that have more muscle, more Botox is necessary. At this time should we visit with your doctor to determine if this incomplete result can be fixed with additional Botox to these areas. 

Resolving Incomplete Botox smoothing of Crow's Feet Wrinkles

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The wrinkles you are referring to may be either DYNAMIC (seen only when you smile) or PASSIVE (seen at rest as well).

To assure ourselves that enough active Botox was placed, I would start by re-treating the persistent wrinkles with a few more units of Botox. Then in a week's time, when the effect of Botox would be fully established, we would re-asses and see if we have the situation corrected. If not, the wrinkles are most likely PASSIVE (seen at rest) and less dependent of muscle contraction. These wrinkles can be vastly improved with a filler such as Juvederm or Restylane.

Dr. P. Aldea

Peter A. Aldea, MD
Memphis Plastic Surgeon

Still have crow's feet after Botox

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It's hard to say what's happening for sure without seeing the wrinkles you are speaking about. It's possible that a bit more Botox might be required. It's also possible that the lines you are speaking about need to be addressed with fillers rather than Botox. It depends on how close to the eye the lines are, whether they get worse when you smile and whether they are located at the outside of the eye or under the eye.

We'd suggest getting back in touch with your injector and going back for a visit to address your concerns. Maybe it's a simple solution like a couple more units. Hopefully so! Good luck.

Harold J. Kaplan, MD
Los Angeles Facial Plastic Surgeon
4.4 out of 5 stars 7 reviews

Wait for one week, more Botox might be needed or resurfacing

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A few thoughts on this:

  1. You might need another dose of Botox to relax the lateral orbicularis muscle.
  2. Wait for one more week for full Initial Botox effect.
  3. Static lines as previously mentioned here will not go away with Botox but will require fillers or resurfacing with laser or peel.
  4. There is a surgical procedure done to cut the lateral orbicularis and make these lines go away completely.However, this is only done during a face lift or lower eye lid surgery.

Hope that helps!

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.