Dr. What can I do about wrinkles that are now more prominent under my eyes since having an under eye filler 2 weeks ago? (photo)

Hello Dr. I'm 46 but now I feel I look 86. I had 40 units of botox injected around my eyes for crows feet and a full syringe of Beletero under eye filler. now I have more noticeable wrinkles than I had before. What can I do if anything about the wrinkles under my eye that are causing me to look worse now especially when I smile?? as you probably guessed this was my first experience with Botox and under eye fillers. Thanks for your time, Cheryl

Doctor Answers 10

Wrinkles Under Your Eyes

Appears to me that you have two issues but both are likely related to loss of elasticity in the skin under your eyes.   I would likely offer you two options .  An under eye phenol chemical peel would help improve elasticity and you would perhaps notice a difference when smiling. A lower eyelid blepharoplasty with tightening of excess skin is another alternative and we often combine it with the peel  albeit at least a month or two apart.


Lexington Facial Plastic Surgeon
4.8 out of 5 stars 14 reviews

When Botox and Filler Aren't Enough

Many patients are interested in non-surgical eyelid rejuvenation. Botox or Dysport around the eyes and Restylane or Belotero under the eyes can give a dramatic improvement. For patients who also have loose eyelid skin, resurfacing with a TCA peel or fractional laser further enhances the outcome. The only way to know for sure what you would benefit from is to have a formal consultation in the office.

Steven M. Daines, MD
Newport Beach Facial Plastic Surgeon
5.0 out of 5 stars 9 reviews

More Wrinkles After Filler

Hi Cheryl. It's hard to tell from the photos what the result looks like because the lighting is very different in both.  

One possibility if your skin looks looser under the eyes is that the Botox migrated from the crow's feet area down below the eye and caused some muscle weakness.  If this is the case, the issue should resolve within a month or so.  

Finally, 1 CC of Belotero is a fairly small amount and usually does not have a large impact on the type of wrinkles you have.  You may need more product.  

For examples of before and after pictures for under eye wrinkles for other Cypress, CA patients, click the link below.

Harold J. Kaplan, MD
Los Angeles Facial Plastic Surgeon
4.5 out of 5 stars 8 reviews

Dr. What can I do about wrinkles that are now more prominent under my eyes since having an under eye filler 2 weeks ago?

Over the internet very hard to advise. Best to seek IN PERSON opinions. But you might needs an under eye medium peel or even a operative lower lid bleharoplasty... 

UnderEye Wrinkles

You likely need laser resurfacing and chemical peeling.  Laser genesis is helpful as well for these lines. If they are more prominent from smiling alone, a few units of Botox right under the eyes is also helpful.  I'd love to see before photos as well.  Overall, you need a cosmetic dermatologist who specializes in lasers, fillers, and surgery to help.  I would gladly see you anytime. Best, Dr. Emer.

Jason Emer, MD
Los Angeles Dermatologic Surgeon
4.9 out of 5 stars 168 reviews

Under eye wrinkles

I see that in your after photo you are smiling and the camera is above you, whereas in the before your face is at rest and the camera is more centered.  When you smile and hold the camera above the wrinkles will look worse or be accentuated.  It would be best to see a before/after photo where you have the same expression and the camera is in the same position.  

If you are bothered by under eye wrinkles which were not improved by Botox and Fillers, I recommend either laser tightening or radiofrequency tightening.  Chemical peels are riskier in darker skin types for giving discoloration, whereas a fractionated laser 1550nm or radiofrequency heating will improve the wrinkles with very little risk.  

Karen Stolman, MD
Sandy Dermatologic Surgeon
5.0 out of 5 stars 7 reviews

Botox and Filler treatment

Dear Cheryl K,
The Botox treatment for crow feet lines and fillers in tear trough areas may some time cause appearance of 'Eyebags' in lower eyelids. In your case, Botox treatment seems to be less effective in lower one third. If wrinkles are bothering you, you can have more botox in lower one third of Crow feet lines ( although total 25-30 units for both sides are generally adequate in cases like yours).  If you have swelling in lower eyelids area, avoid more botox and let filler settle down in nest 10-15 days.

Dr K M Kapoor

Wrinkles worse under eye after Botox and filler will improve

40 units of Botox is too much for around the eyes. I use 1/2 that. Losing that much tone can actually lead to more wrinkles. Under eye laxity can be treated with laser, surgery, or RF. I like the Infini for the RF treatment. You should go back to where you were in about 3 months. At that time address the skin laxity. 

Steven F. Weiner, MD
Panama City Facial Plastic Surgeon
4.6 out of 5 stars 27 reviews

Under Eye Wrinkles and Fillers

The photos are difficult to assess the problem.  If the Botox can fillers created a worse problem I suggest you return to your treating physician and have them dissolved.  The Botox injections may have been placed too low to your under eye area.  Those effects can last two more months.  Please consult a board certified dermatologist with a great deal of experience with Belotero and other facial fillers.

Under Eye Wrinkles

It appears in your after photo that you are smiling a bit, which will always cause wrinkles under the eyes whether botox has been placed or not.  Chemical or laser peeling would improve the fine under eyelid wrinkles at rest but when you smile they would still show to a degree. A conservative "skin pinch" blepharoplasty can also smooth the lower eyelids at rest as well.  You are probably a very expressionistic person that smiles a lot and thus your lower eyelid wrinkles.  I would talk to the person that treated you and see what ideas they have or who they would refer you to.  Sorry if this is discouraging, but it is very hard not to have lower eyelid wrinkles when we smile.  Best wishes.

John R. Burroughs, MD
Colorado Springs Oculoplastic Surgeon
5.0 out of 5 stars 14 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.