Dynamic Crowsfeet. Botox Ineffective. Alternatives?

When I presented for botox the plastic surgeon said that Botox would no longer be effective for my dynamic crowsfeet. I do not have passive crows feet. What is an effective treatment/procedure to treat the crowsfeet that appear when I smile?

Doctor Answers 7

Botox can work for active crows feet, partially

There are two components to the crows feet. Both the squint muscles and smile muscles are responsible for making some patients' crows feet. The circular muscle around the eye causes the horizontal and diagonal lines from the corner of the eye outwardly while the lines below and parallel to this region that extend over the cheekbone towards the lower eyelid are caused by the diagonal muscles that cause us to smile and come up from the corner of the mouth and upper lip. 

When crows feet are long standing they get deep enough to maintain their crease even when you're not actively squinting with the eyelid muscle or smiling with the mouth muscles.  In order to relax the muscle to prevent the smile muscle creases near the lower eyelid and over the cheekbone, Botox would change the way the mouth opens. Therefore, full correction of those lines can't be done. However, Botox that treats lines with motion well, can treat those same areas if the lines are not observed at rest but only with motion, provided the muscles that are moving are not the lip smile muscles. We often treat patients who are concerned about their crows feet when smiling but they have to understand that not all the lines towards the cheekbone and lower eyelid will be treated for the above reason.

The information provided in Dr. Shelton's answer is for educational purposes only and is not intended to constitute medical advice.  The information provided should not be relied upon as a substitute for consultations with a qualified health professional who may be familiar with your individual medical needs. 


Manhattan Dermatologic Surgeon
4.9 out of 5 stars 38 reviews

Botox for crow's feet.

It does seem strange that you were told Botox would no longer be effective for crow's feet. Did it stop working? There are several other alternatives similar to Botox if you have developed a resistence. Ask your plastic surgeon why he/she feels you are no longer a candidate.

Brian J. Lee, MD
Fort Wayne Plastic Surgeon
5.0 out of 5 stars 13 reviews

Dynamic Crow's Feet

I guess my question is: why did the plastic surgeon say this exactly? You said "no longer" which leads me to believe you've had Botox there before... Is it not lasting as long? If this is the case, you could try to switch to Dysport. Even though the products are very similar, they are just different enough that some people will respond to Dysport better. In this case, I often switch people back and forth between the products for best results.

F. Victor Rueckl, MD
Las Vegas Dermatologist
4.6 out of 5 stars 17 reviews

Dynamic Crow's Feet Botox Treatment

The crow's feet can be a challenging area to treat.  If Botox seems ineffective, you may need more units or you can try Dysport as an alternative treatment.  Both neurotoxins act on the muscle fibers that encircle the eye.  They do not act on the muscles that control your smile,and you do not want them to do so.  When you smile, the skin has to go somewhere.  As a result you will always have some crow's feet/movement of skin around your eyes!

Sheri G. Feldman, MD
Beverly Hills Dermatologist
5.0 out of 5 stars 1 review

Dysport or Botox are both effective for dynamic crow's feet.

If you are not getting enough botox injected at a time, maybe you don't see the improvement you want.  It is very common for people to underdo botox to save money. That is a big mistake. Botox/Dysport almost always works if you get enough injected. Sometime it works great with only a small # of units but that is not the case most of the time. This is why we charge per area so i don't skimp on the botox just because that is all the patient wants to  pay.  When you pay by the area, you get whatever the doc feels you need to accomplish the end results.1 area such as crows feet together is $300, 2 areas such as crows feet and frown lines are $550 and adding the forehead as the 3rd area is $750.  Sincerely,

David Hansen,MD

David Hansen, MD
Beverly Hills Dermatologic Surgeon
4.7 out of 5 stars 43 reviews

Dysport is extremely effective for treating crow's feet

In the rare cases of patients becoming resistant to Botox over time, Dysport is generally quite effective. In my experience, the results patients can expect in the crow's feet from the two products are quite similar and patient satisfaction is very high. 

Best regards,

Dr. Mehta

Umang Mehta, MD
Bay Area Facial Plastic Surgeon
4.7 out of 5 stars 49 reviews

Dynamic Crowsfeet. Botox Ineffective. Alternatives?

We offer the DOT Co2 Laser for facial laser resurfacing.  This is very effective in softening the lines in the face and is very good for crows feet. 

Stuart B. Kincaid, MD, FACS (in memoriam)
Beverly Hills Plastic Surgeon
3.3 out of 5 stars 9 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.