Botox causing bigger dents - what could be the reason? (photos)

Question

I’m 37 years old and it’s second time I get Botox around the eye area (crown’s feet) and the skin on my left eye instead of stretching out stretching opposite direction. The closer I get injected to crown’s feet the bigger the dent becomes. I don’t understand why. Could you explain what it might be ?

Anna Chacon, MD, FAAD · Answer

Thank you for sharing your experience—it sounds frustrating, and it’s understandable to be concerned when Botox seems to make an area look worse instead of smoother.

What you’re describing—where the skin near your crow’s feet appears to “dent” rather than relax—can happen for a few reasons:

Injection placement and muscle dynamics: Botox works by weakening the muscle it’s injected into. Around the eyes, the muscles are very small and interconnected. If the Botox spreads slightly into the wrong spot or the injection is too close to the outer skin, it can cause uneven relaxation. Some areas may relax more than others, which can create a temporary “dent” or hollow look.

Pre-existing volume loss or thin skin: Sometimes, the skin around the eyes is already very thin, and repeated muscle movement can reveal subtle hollows. When the muscle is relaxed, the skin can settle differently, making a dent more noticeable.

Individual anatomy and asymmetry: Each side of the face can respond differently to Botox. If one side has slightly stronger or tighter muscles, or less underlying fat, Botox may have a more noticeable effect there.

Injection technique and depth: In some cases, if Botox is injected too superficially or in the wrong layer, it can pull the skin in the opposite direction rather than smoothing it out.

This doesn’t mean something is “wrong” with you—it’s often just the interaction between your anatomy and how Botox spreads. Usually, these dents are subtle and can improve over time as the Botox settles, or with minor adjustments in future treatments.

It’s completely normal to be sensitive to small changes in the delicate eye area—it’s one of the trickiest spots for injectables!

Albert Yang, MD · Answer

When your smiling, the cheek comes up and causes folds under the eye. That muscle is not able to be treated with botox unfortunately. Everyone will be a little asymmetric. You would benefit from laser and a skin pinch bleph though, which will improve it.

Glenn Lyle, MD · Answer

This is a common problem that can happen after Botox treatments. You just need a little more around that eye and some in the jelly roll under that eye. Our bodies are not symmetric and have to be treated accordingly. You look as if you pull harder on that side when you smile. Have your injector take another look and ask for a little touchup.

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