Wrinkles after botox crows feet. What went wrong? (Photo)

Question

After treated with botox (crow feet & frown) I began to get (more) wrinkles under my eyes. What went wrong? It's been 6 weeks now (see before & after photo) and it's still terrible.

Parker A. Velargo, MD, FACS · Answer

If Botox is injected in significant quantities to the muscle under the lower eyelid, you can be left with such crepiness (and even more pronounced fat pockets).  This is because the muscle is no longer able to contract or tighten as before the treatment.  My suggestion is to let it wear off, then consult with a facial plastic surgeon or plastic surgeon to weigh both surgical and non-surgical options to correct your areas of concern.  This situation stresses that only "core" injectors should perform cosmetic injectables (facial 
plastic surgeons, plastic surgeons, dermatologists, or occuloplastic 
surgeons).  This is because we all have a keen understanding of facial 
anatomy and the effects of injecting Botox and fillers in different
 regions of the face.  Be sure you are seeing one of us, and I wish you well!

Martin Jugenburg, MD · Answer

It appears as though you are not a candidate for under eye Botox injections. If you have preexisting skin laxity or water retention to the under eye, Botox injections should be avoided. When skin laxity is apparent Botox can add to the appearance of water retention and wrinkles. Botox typically lasts 3 months. It will wear off. Best of Luck.

Jessica Lattman, MD · Answer

If the eyelids are not properly evaluated before treatment with botox, the botox can cause a sagging of the lower eyelid musle/skin.  If the injections are place under the eyelid and there is already some laxity of the muscle, the muscle will droop more and look like the lines that you see.  There is nothing much to do except wait for the botox to wear off.

Joseph A. Eviatar, MD, FACS · Answer

Botox is a muscle relaxer and will relax the muscles into which it was injected.  Sometimes other muscle wrinkles become more evident and can be injected.  Other times the muscle is not injected completely evenly or the botox doesn't take evenly.  A touch up treatment can usually solve this issue so see your injecting doctors and most will do a small touch up at no additional charge.  If that is not satisfactory, see an injection specialist who has experience injecting around the eyes.  Often combining a little filler with botox or using a device to improve the fine lines such as Thermismooth can be helpful to get the best results from Botox.  There are various treatments to help with the issue of wrinkles around the eyes in addition to, or instead of Botox so a specialist should be able to explain these options to you and come up with a good treatment plan.best of luck!

Dean P. Kane, MD, FACS · Answer

Hi Perryi:

Botox
relaxes muscles. When those muscles arealong
the lower eyelid:

1.1 pushing back the fat pads of the lower eyelid,
or

2.2 compressing fluid accumulation in the inferior
orbital region or

3.3 lifting the skin under the eyes,

more wrinkles and sagging will occur.

The
average duration of Botox is 3 months, so you may expect these effects to occur
for that period of time.

I
recommend you visit a Board Certified, well experienced Plastic Surgeon, Facial
ENT or Oculoplastic Surgeon to review your options once this episode wears off.

In
the meantime, consider a skin tightening program such as:

1.1 retinoids

2.2 TCA chemical peel

3.3 skin tightening laser

I hope this was helpful! All the best!

Sheryl D. Clark, MD, FAAD · Answer

It looks as though you may have had some Botox injected in the portion of the periorbital muscle that is under the eye as well as the crow's feet.  Especially in individuals who have had lower lid blepharoplasty or who have swelling around the eyes with water retention, the lymphatics may not drain the water that normally accumulates around the eye becuase of the weaker contractions of the periorbital muscle. After the swelling goes down, one us left with the kind if wrinkles you seem to have.If you don't wish to wait for this to resolve, you can hasten it with a potent green tea cream (Replenix) combined with a few Pellevé treatments. It will improve dramatically.By the way, this does not have to happen unpredictably. Performing a 'snap test' before Botox treatment can predict to a large extent who is likely to have this side effect.

Wrinkles after botox crows feet. What went wrong? (Photo)

Answers (6)

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