Is Botox not enough for under my eyes/crows feet? (photos)

The lower eyelids would be better treated with something else. Consider peels, laser skin treatments or even surgery if you'd like to pursue that route.

There are many ways to treat dark circles, as well as under eye wrinkles and bags. It is important to note however, that the majority of times the cause for discoloration is genetic and due to the viability of the blood vessels below the skin. A combination approach is always needed to get the best results in this area and this includes: topical skin care, laser and/or radiofrequency treatments, and fillers if placed appropriately. All my patients are on topical lightening agents, typically a vitamin C serum product in the AM and a brightening agent and/or a vitamin A based product in the PM. Sun protection is essential.Resurfacing and tightening are essential. My patients get offered a menu of options, for which a combination gives the best results. Light salicylic acid peels help give textural and pigment improvement; nonablative lasers (Fraxel or Clear + Brilliant) can be used to tighten and improve fine lines/wrinkles and crepe skin; fractional radiofrequency devices (Sublative, Viva) are cutting edge and improve texture, tone, and wrinkles with very little downtime; radiofrequency with pulsed electromagnetic fields (Venus) are amazing for puffiness and bags, in patients who do not want eyelid surgery; appropriately placed fillers can replace lost volume, cover up the vessels and fat pads below improving the appearance -- patients should pick a well experienced practitioner to prevent complications such as Tyndall (blue discoloration) and irregularities, one that uses a cannula for injection will help give results with little bruising or swelling; microsecond Nd:YAG laser treatments (Laser genesis) has produced dramatic improvement in discoloration in some of my patients and is safe in dark skin types, similar to the radiofrequency devices. For lifting, ablative laser resurfacing such as co2 laser combined with monopoloar radiofrequency deep heating (thermage) give amazing results. The key is for a patient to see a cosmetic dermatologist with experience in all the latest devices and techniques so the persons goals can be met by a combination approach of individualized treatments and skin care. In some cases, those who smile and have crepe skin or under eye wrinkles, a small amount of neurotoxin (botox, dysport, xeomin) strategically placed in the lower eyelid skin can improve wrinkles dramatically and give the eye a more "open" appearance.

Hello dollyolive,Thanks for your question.  Your concern is a typical one.  It appears that the Botox to your outer crow's feet is working from your smile pics.  The small wrinkles due to orbicularis muscle function under the midpoint of your lower eyelashes are harder to treat.  If you take the risk to place low dose Botox in this part of the muscle you could loose muscle support to your lower eyelid creating a sag.  In my experience, injectible filler and laser resurfacing are helpful to smooth this area out.  I have no experience with Ultherapy, but I would have some reservations about getting hi-intensity ultrasound so close to the eyeball itself.  Also, lower eyelid blepharoplasty that allows skin release and muscle redraping can improve this area, but it is the most invasive option.  I find that gentle cautery to the orbicular is muscle helps decrease the "roll" of muscle you see.I would recommend you consult with a specialist in cosmetic eyelid surgery to come up with a safe and reasonable plan to address your concerns.Good luck,Dr. Shah

Great question.What you describe is quite appropriate for botox treatments in the periorbital region.The muscle around the eye is called the orbicularis muscle and is circular. When it contracts it acts like any other circular muscle, like the orbicularis oris muscle around your mouth.  When you contract that muscle you squeeze your lips like your going to whistle. Around the eye, the muscle "squeezes" the eyelids and keeps the eyelids tight up against the eyeball, a necessity for normal eye function. The crows feet portion of the muscle can be paralyzed with botox successfully with resolution of the wrinkles. However, if botox is used to paralyze the muscle on the lower eyelid, you will experience drooping of the lower eyelid, much like you might see in people who have had a stroke. The point is, the wrinkles on the lower lid are not really safely treatable with botox, in my opinion. If the wrinkles only occur with animation (smiling) then you might have to accept that as your normal. Other options include a good skin care program, laser resurfacing and lastly blepharoplasty, although I don't see from you photos as the best option for you. I truly hope this helps

Dolly,First let's address the issue of what causes crows feet and under eye laxity.  The last few years since dermal-fillers have come on the scene in plastic surgery, we as cosmetic surgeons have come to realize the importance of facial volume loss and the significance this plays in aging.  In the past we usually would address the issues with which you are concerned with Botox, chemical and laser peels, and lower lid trans-cutaneous belpharoplasty.  All of these options most often were able to meet the patients' needs. Now with dermal-fillers at hand they have played a large part in revolutionizing facial aesthetics in obtaining a more youthful appearance. Injecting filler into these areas can provide a more youthful appearance when used in conjunction with the above named techniques.  So to answer your questions, if Botox is the only thing to use, the answer is no.  But every patient must be assessed as to their needs, financial capacity to pursue the recommended course, the downtime and the objective of the overall final result.  It is always advisable to seek out a board certified plastic surgeon with experience, one that will address your needs and concerns and that is willing to work with you to accomplish your goals.

      Each patient is different but you have several treatment options.  First, no treatment is required.  There is a slight risk of temporary problems with Botox for lower eyelid thickening.  A chemical peel (pure phenol or Baker-Gordon formula) will often help as will laser resurfacing but there is a down-time of of 10-14 days with a chemical peel and 5-7 days or more with laser resurfacing.

Botox is definitely necessary in the area for the dynamic lines that occur with smiling. But if its the wrinles and looser texture on the lower eyelids that concerns you, I recommend laser resurfacing, particularly fraxel repair. The texture will be better and skin will be tighter. It will take a week to recover.

London, Texas - Sometimes 2-3 units of Botox is used in the lower eyelid to treat hypertrophy of the orbicularis muscle. In essence, the orbiculris muscles of the lower eyelid cause "crinkling lines" and are responsible for holding the lower eyelid against the eye. What you are describing and showing on the photos are these ridges under the eyes when you smile - because when you smile, your cheeks are raised and crinkle the skin under the eyelid. I hope this explains why this occurs.So, this is considered a problem area for aesthetic physicians and practitioners. Those that are not experienced with treating this subtle but important issue for many women will not recommend that you have Botox placed under the eye. The key is to use a judiciously small amount of Botox to relax the orbicularis muscle but not weaken it - weakening this muscle will result in sagging of the lower eyelid margin. You would not like that effect either. Some may be better off having the lower eyelid filled with hyaluronic acid fillers - but, this would be "too much" in your case and I do not recommend it as a treatment for you. The alternatives are laser resurfacing but specific recomendation should be made with an in person evaluation by someone who has experience with all of these techniques including Ultherapy (see next paragraph). You can treat the area under the eye but not right up to the lower lid with the new 1.5 mm Ultherapy transducers. The treatment needs to be kept outside of the orbit of the eye. The full effect will take 3-6 months from the time of treatment. Read the Ultherapy book provided on the link below under the ebooks section. It is written by a Los Angeles Plastic surgeon Dr Raffy Karamanoukian who is often featured on 'The Doctors TV Show'.