Why has Botox in my crows feet caused weird lines under my eyes when I smile? (Photo)

Botox is a great way to smooth crows feet and improve lines around the eyes.  However, sometime treating one area will result in increased movement in other to compensate.  It is difficult to tell without a before or dynamic photos.   However, it may be that a small amount of botox under the eye may fix your problem.  Return to your physician and get their opinion.  Best of luck.

Crows feet at the outer eyelids are caused by squinting muscles of the eyelids but also from some contribution, in many people, from smile muscles.  If part of the upper smile muscles where they insert near the cheekbone are affected, then the rest of the functioning smile muscle, or at times, the mid lower eyelid muscle, overcompensates with activity because it is trying to function for itself plus the relaxed muscle and then new creases are seen from this muscular contraction squeezing the overlying skin like accordion bellows. This is not permanent and will go away when the Botox wears off.The information provided in Dr. Shelton's answer is for educational purposes only and is not intended to constitute medical advice.  The information provided should not be relied upon as a substitute for consultations with a qualified health professional who may be familiar with your individual medical needs. 

Thank you for sharing your question and photograph.  I would speak with your injector to evaluate your before and after images.  These lines may have been present before and deepened as you said due to muscle redistribution.  If this is the case a small amount of Botox added into the lower eyelid should help.  

Crow’s feet Botox targets a portion of the orbicularis oculi muscle.  This muscle forms a ring around the eye and squeezes the eye shut from all directions when activated.  Botox relaxes the muscle selectively in the lateral portion of the muscle where it is injected, so that the sides of the eye do not wrinkle when the muscle is engaged.  Occasionally, after Botox, other portions of the treated muscle or nearby muscles will “over compensate” and contract more strongly during movement.  This can lead to new wrinkles becoming visible following a treatment.  The lower eyelid is a common area for this.  It is an option to inject a very small amount of Botox directly into the lower eyelid where you are seeing the new wrinkles in order to help relax them, but it may or may not fix the problem.  Your provider should evaluate your result and decide whether they think additional intervention is warranted or if you should just allow the Botox to wear off.  Rest assured, this is just temporary, and any “new” wrinkles will resolve and the face will return to normal given time.  Best of luck!

Thank you for your question! Botox is a great way to smooth crows feet and improve lines around the eyes.  However, sometime treating one area will result in increased movement in other to compensate.  It is difficult to tell without a before or dynamic photos.   However, it may be that a small amount of botox under the eye may fix your problem.  Return to your physician and get their opinion.  Best of luck!

Thanks for the pictures and question.  I have seen what you are describing, and it usually is because the orbicularis oculi muscle, which is responsible for the Crow's Feet. also supports the skin of the upper face to a certain degree.  You may have lost some of this support due to the muscles relaxing and it is manifesting under the eyes.  I have also seen this when people try to treat the crow's feet too aggressively and try to stamp out every line.  This can also lead to over-relaxation of this muscle.  This, like all effects of Botox, will wear off after time, so I would not stress about it too much.  

Hello there! I have seen this happen, on occasion, to patients following Botox in the crows feet. It is a result of muscle movement changes due to relaxation of some muscles, and increased movement in others. This happens in response to the treatment in that area. For some patients, treating the under eye with a small dose of neurotoxin, will correct this concern. For others this area is very tough, and may need other treatments to enhance the skin quality. Eye creams, microneedling, and laser treatments are some of the options we have in our office. Good luck!  Sarah RN BSN 

Sometimes injection of the Crow's feet area relaxes the muscles in that area and the other muscles around the eye that are not relaxed make the appearance of these lines. These lines can be relaxed by a small dose of botox in this area. 

These lines are caused by active muscle still moving during smiling. It is possible to inject a unit or 2 under the eye in these areas to improve the lines. A snap test must be done prior to ensure there is enough tension in the lower lid. If there is laxity already, Botox might cause ectropian, which is when the lower lid everts and doesn't close properly. In general, in younger patients, this is well tolerated.

Thank you for your question and for sharing your photograph bthomasa72. 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 in the absence of consistent photographs before and after in the same lighting and angles for comparison. 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.A phenomenon seen with Botox is called muscle recruitment and compensation. When a muscle has been relaxed with Botox, sometimes other muscles or a different part of the same muscle are recruited and contract when one attempts to make the facial expression. This serves to compensate for the inability of the primary muscle to contract. Sometimes a bulge can appear in a muscle that was untreated or a part of a muscle that was not treated. A common example is the bunny lines (caused by contraction of the nasalis muscle) that are seen on the sides of the upper nose after treatment with Botox in the glabella or for the crow's feet. Since the muscles in the treated area are relaxed, the nasalis muscle contracts in an attempt to compensate for this loss when one frowns or smiles. In such a situation, the bunny lines can be treated with a small amount of Botox (2-4 units per side). In the upper face, sometimes a portion of the frontalis muscle in the upper forehead which was previously not active becomes active once the muscle is relaxed with Botox. In these case, new wrinkles may be seen, often near the hairline. This can be treated with a small dose of Botox in that area. This can also be seen in the lower face when not enough product has been used in an area such as the chin. Sometimes another part of the muscle begins to contract in order to compensate for the relaxation of the muscle from Botox. This can also be treated with a small dose of Botox in that area. Compensatory recruitment can also occur when the platysma muscle in the neck contracts after muscles in the lower face have been relaxed with Botox. Similarly, this muscle can be relaxed with Botox as well. For my patients, I usually use approximately 10 units per band. If placed properly it does not affect other muscles. Relaxing the platysma muscle may also lead to an improvement of jowls and jawline definition. When such recruitment occurs, I recommend prophylactic (preventive) treatment of the recruited muscles at the next treatment.If I had a patient with the concern described here I would likely say that the new wrinkles are secondary to such compensatory recruitment. The muscle itself is not being redistributed. Instead, the part which is not relaxed is contracting in an effort to compensate for the part that is relaxed. This can likely be corrected with a small amount of Botox placed directly under the eye(s).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!