Fillers or Botox for downward sloping eyes & under eye wrinkles? (Photos)

While it is likely you could have help with under eye fillers, it is critically to get the right filler.  Runny products like Belotero have no place in treating the lower eyelid. The principle product used for this area is Restylane. It is a fussy product and requires a very experienced injector to place this product. I also think you need to be assessed for eyelid surgery. Due to the two radically different pictures, I would be careful about advice based on just these pictures rather than a personal assessment.  Find cosmetic surgeons who know what they are doing.

Hi,You have whats called a negative canthal tilt. Fillers and botox will not address this and surgical correction to tighten and reposition the lower eyelid is necessary. You need to see someone who specializes in eyelid surgery for the best outcome.Best,

A combination approach will give the most improvement. Fillers, lasers, and microneedling/PRP can improve under the eyes. My patients try to get non surgical treatments to avoid surgery. We use PRP and stem cells there often. I suggest consulting with an expert to develop a treatment plan best suited for your short and long term goals. Best, Dr. Emer

Thank you for your question! While it is likely you could have help with under eye fillers, it is critically to get the right filler.  Runny products like Belotero have no place in treating the lower eyelid. The principle product used for this area is Restylane. It is a fussy product and requires a very experienced injector to place this product. I also think you need to be assessed for eyelid surgery. Due to the two radically different pictures, I would be careful about advice based on just these pictures rather than a personal assessment.  Find cosmetic surgeons who know what they are doing. Best of luck!

Hello. Thank you for your question. Under eye filler will help you achieve a less tired looking eye and less fine lines. Your provider may also suggest a combination of filler and Botox to help with the tiredness and wrinkles. It will really depend on your consultation and how the wrinkles change with movement. 

Hello and thank you for your question. Lower eyelid wrinkles can be treated in several ways. For coarse wrinkles that are related to muscle activity consider Botox treatment and possibly a small amount of strategically placed fillers. These injections are tricky and I strongly recommend you see an experienced physician such as a plastic surgeon who is well aware of the anatomy. On the other hand for fine wrinkles consider consistent skin care that includes Retin-A and sun screen. For the down slanting of your eyes there is not a non surgical option. That is corrected with surgery. Or if you want to fix all of these problems once and for all, consider a lower blepharoplasty, which will remove the wrinkled skin, microfat droplets to correct the dark circles and correct the down slanting of your eyes. It is a relatively quick procedure and is one and done. 
I hope this helps and wish you all the best.

Oculoplastic Surgeon 
Inzhili Kitto, M.D.

Instagram: @dr_Kitto

Hello aliceanne,Great question. For your wrinkle concern under your lower eyelid, microneedling, maybe subtle botox or very light peel may help. For the dark circle and hollowness, a subtle hyaluronic acid filler could help. Regarding your downward slant, this is best corrected surgically. Botox will not help this. A simple procedure will raise your lids to re position them nicely. My suggestion is to seek out an expert oculoplastic surgeon to have this discussion. Hope this helps.Cheers

When it comes to nonsurgical eye rejuvenation, I find that patients see best results when a combination of different treatment modalities are used. This includes neuromodulator like Botox and Dysport for dynamic lines and wrinkles (i.e. crow's feet), HA fillers like Restylane for undereye volume loss, and skincare treatments (lasers, microneedling, topical products) to improve the quality of the skin. In your case, I would probably consider Botox or Dysport, Restylane and a good eye cream. 

Thank you for your question and for sharing your photographs aliceanne. I understand your concern. Botox is a purified protein used to address wrinkles associated with facial expression. When injected into the skin Botox will relax the muscles and smoothen out the overlying wrinkles. The most common areas of treatment are in the upper face. These include the horizontal lines seen on the upper forehead when one raises the brows, the vertical lines seen between the brows when one frowns (frown lines), and the crow's feet seen around the eyes when one smiles.It is difficult to make an assessment without a formal exam in the office where I can view the skin in multiple angles and observe wrinkles formed with facial expression. However, I hope the information provided here is useful.The pivotal studies used 24 units of Botox (12 units per side) to address the crow’s feet. These studies demonstrated that the peak results are seen 14 days after the treatment and most people enjoy their results for 3-4 months. At that point, a maintenance treatment is recommended. While some people start to see results as early as the next day, it can take two weeks for full results so patience is important. We have our patients return two weeks after their treatment to assess their results via photographs. At that time additional units may be added if necessary.In addition to addressing various wrinkles, Botox can also be used to adjust the position and shape of the eyebrows. It works the same way as it does when addressing wrinkles, namely by relaxing muscles. In the upper forehead, there are muscles that move the eyebrows up and other muscles that move the eyebrows down. The muscle that moves the eyebrows up is on the upper forehead; this is called the frontalis muscle. It is responsible for the horizontal lines seen on the upper forehead when one raises the eyebrows. The muscles that pull down on the eyebrows are located between the eyebrows and at the corners of the eyebrows. The muscle group between the eyebrows is called the glabellar complex. There is another muscle that goes around the entire eye called the orbicularis oculi muscle. The portion of this muscle under the tail of the eyebrow is responsible for pulling down on the tail of the eyebrow. When any of these muscles is relaxes with Botox the position of the eyebrow can be adjusted. When treating the horizontal lines on the upper forehead seen when one raises the eyebrows, if the dose is too high or if the placement of the product is too low it can lead to the feeling of a heavy eyebrow, difficulty raising the eyebrow, or downward movement of the eyebrow. This can also lead to downward movement of the eyelids, making a person appear tired. It also can make it difficult to apply eye makeup. To correct this Botox is placed in the antagonistic muscles, those in the glabella and orbicularis oculi which pull down on the eyebrows. This will raise the position of the eyebrows. These two areas can be treated with Botox to provide a brow lift. To do so 4-20 units of Botox are used in the glabella between the eyebrows and 2-12 units of Botox per side are used at the tail of the brow and/or the entire crow’s feet region.Some people have narrow eyes that make them appear tired. A small amount of Botox (1-2 units) placed directly under the eyes can help to relax the muscle that goes around the eyes. This causes the lower eyelid to open up more, providing a more healthy and rested appearance. It is important to assess the patient before this treatment by doing what is called a snap test. A snap test demonstrates whether the skin is loose in a given area. The skin is pulled away from the face and released, allowing it to retract. If the skin is tight this retraction is seen right away. On the other hand, if the skin is loose, the skin will retract to its original position slowly. In this case, Botox is not recommended in this area. This is because the loose skin would not be able to close the eyes appropriately. If the muscle is relaxed with Botox it may be difficult to close the eyes and blink. This leads to dryness in the eyes, which can cause further complications.Botox and fillers are two dermal (skin-related) products are both very popular for their anti-aging features. Unlike Botox, which relaxes muscles to smoothen out wrinkles associated with facial expression, fillers restore lost volume in various areas of the face and body. Common fillers include the Juvederm family (Juvederm Ultra, Juvederm Ultra Plus, Voluma, Vollure, and Volbella), the Restylane family (Restylane, Restylane Lyft, Restylane Silk, Restylane Refyne, and Restylane Defyne), Belotero, Radiesse, Sculptra, and Bellafill. With age changes occur in the bony structures as well as fat pads, both of which contribute to a youthful appearance. Over time bones move and change shape while fat pads get smaller by losing volume and move downward. Fillers restore such lost volume. Common areas of volume loss include the temples on the sides of the face, the upper cheeks, the tear trough area under the eyes, the nasolabial folds which go from the sides of the nose to the corners of the mouth, the marionette lines which are the continuation of the nasolabial folds to the jawline, the chin, and the jawline. Often times combining fillers with Botox treatments yields superior results.If I had a patient with the concern described here I would want to look at the skin in multiple angles with and without facial expressions. I would say that the patient may be a candidate for Botox around the eyes and for Botox to elevate the brows, which may help elevate the downturned corners of the eyes. I would also say she is a good candidate for a filler such as Vollure under the eyes to help with the hollowing.With any injection, there are risks such as pain, bleeding, bruising, redness, swelling, tenderness, and infection. We take special precautions to minimize these risks such as using a painless technique. We also treat bruises with a laser as early as the next day. Bruises usually resolve within two weeks if untreated. After a laser treatment bruises usually resolve in 1-3 days, but may still take two weeks for full resolution. In addition to these risks, with Botox there is also a risk that the product spreads or diffuses to nearby structures. Spread to nearby muscles can lead to side effects such as the temporary appearance of droopy eyelids or a temporary asymmetric smile.

After a Botox treatment, I recommend that my patients avoid heat exposure, alcohol consumption, and strenuous exercise for 24 hours and not lie down flat for four hours. This is because all of these activities may possibly lead to the movement of the product and consequent side effects such as droopy eyelids. Although there have been no definitive studies shown that these actually occur and some physicians do not provide such aftercare instructions, in the absence of data I err on the side of caution and recommend that my patients avoid such activities.

Please consult with a doctor for specific recommendations. Good luck!

The pictures are not good to diagnose eyelid slant because of the position of the eyes for the picture. I do not see much fine lines.If the fine lines are actually in the lower lid, then neither Botox or filler will correct the problem. A good examination in neutral gaze and position of the eye and pupil can determine the downward slant of the lateral canthus.You are not a candidate for either botox or filler.