What is the solution for wrinkles in the eyelid after Botox? (photos)

Thank you for your question. PDO threadlifts may be a solution for the lines under your brows. PDO thread lifts can be used around the eyebrows to lift the skin for smooth and youthful results. The absorbable stitches are strategically placed to lift the skin. Dermal fillers may also help as they can target brow atrophy and wrinkles. An in-person consultation with a board-certified facial plastic surgeon can help create a personalized plan that targets your concerns and leaves natural results.

Botox works by relaxing muscles and smoothening the overlying skin. However, when there is significant skin laxity, you might get the wrinkles that you are talking about. A good alternative is to get an endoscopic brow lift (to lift the brow to where it is supposed to be) and upper blepharoplasty ( to remove the excess skin in your upper eyelids). Hope that was helpful

For puffiness and sagging under the eyes, we often use Renuvion helium plasma radiofrequency energy to achieve incredible results and take years off of your appearance. Combining RF energy and cool helium plasma, the signs of aging (wrinkles, pigmentation, skin laxity) are improved in a ‘Nonsurgical Eyelid Lift.' The focused heating tightens and peels the upper layers of skin with extreme precision, leaving the surrounding area undamaged, smoothing and tightening the periorbital skin, and improving the overall skin quality around the eyes. It's an aggressive treatment, and the recovery time is longer than with other nonsurgical procedures, but the results can be life-changing.​ See an expert to determine if this is the best solution for you. Best, Dr. Emer

The remaining wrinkles are from the muscle (orbicularis oculi) that is still working around the eyes. It is a circular contracting muscle. Some additional botox can help reduce the lines but has to be done in a thoughtful way to avoid problems with brow ptosis.

Hello @Exciting44735, thank you for your question. Botox helps you to relax some muscles that when tensed generate contraction and in turn into mobile wrinkles or expression lines, but in your case I can see that a surgical solution is required for the skin that is left over in the mobile eyelid. You can think of doing an upper blepharoplasty and lift the tail of the eyebrow with an eyebrow pexy. For more information and recommendations, consult one or several board-certified plastic surgeons. Best wishes! Alan Gonzalez MD, FACS.

The wrinkling that concerns you may be related to skin laxity. You may consider AccuTite to help tighten the skin around the eyes and forehead. Visit with a board certified plastic surgeon near you to learn more.

Dear exciting44735,
Thanks for sharing your photo. I see the vertical sub-brow wrinkles you speak of. I also see very flat brows with no forehead horizontal lines. Without a dynamic evaluation of your forehead and peri-ocular muscle balance, I can only guess at the issues causing these unnatural wrinkles. I believe your frontalis muscles have been fully relaxed causing no forehead wrinkle lines and no elevation or arching to the brows. The upper outer orbicularis oculi (oo) eye muscles have also been relaxed creating a compensation of the pre-septal oo medially and therefore wrinkling the eyelid skin. Please consider:
• A second opinion in your botox injection technique, expectations and desires in brow and forehead rebalancing.
• Wait the 3 plus months for the botox activity to completely “wear-away” allowing for a full recovery of the circular eye muscles and forehead raising muscle to re-evaluate your desires and re-design the injection technique.
• You may then re-consider threadlift, fillers, peels and other techniques to reverse your concerns.
I apologize for posting this late and hope it helps. All the best.

Botow is a great solution to help with forehead lines, crows feet, and the 11's you get between your eyebrows. However, in your picture, the area you have circled is not treated with Botox. As we age, we start to lose elasticity in our skin, which is most visibly seen on our face. It's hard to say based on this picture without an evaluation in person, but often times, upper lid wrinkles are an indication for an upper lid blepharoplasty or, also sometimes needed your brows can start to descend with age and can also cause wrinkles in the upper eye. I recommend being evaluated by a beard eligible/board certified plastic surgery.

Regarding the wrinkles under your brows, I would treat that with additional botox. It seems that your treatment plan is a little light and needs more coverage to help balance it out.

As I tell my patients. Botox does not get rid of wrinkles. Botox weakens or paralyzes the muscles that cause specific wrinkles. It looks to me, from you photo, that your botox is causing your brow to drop and these wrinkles are excess skin of your eyelids that has developed over time. Many people then artificially hold their brows up to smooth out the eyelid skin, therefore causing forehead wrinkles. Botox treatments to the forehead are causing the brow to settle, thereby causing the wrinkles on the eyelids to show. I have a feelling Botox is not your answer. Botox the forehead, those wrinkles go away and the eyelid wrinkles show. Don't botox the forehead, and you can hold your brows up and smooth out the eyelid skin, but get your forehead wrinkles back!What is the answer, I would recommend a surgical browlift! Maybe combined with eyelid surgery (Blepharoplasty). So many patients are scared of these surgeries because they see so many that are over-corrected. I tend to be quite conservative, and the results are great! Find a good board-certified plastic surgeon who specializes in facial cosmetic surgery, look at their pictures, talk to friends, and OR nurses, and see who will provide you the best job! Good luck!