Can skin tightening be performed after Botox or along with it to treat jelly roll under the eyes when smiling?

I suggest reaching out to an expert for a formal consultation. I like to recommend my patients start a combination of facial rejuvenation treatments.

1) Skincare with products and microneedling/PRP
2) PDT Light Therapy a few times per month with growth factors
3) Laser treatments like Clear + Brilliant regularly and others (Fraxel, Moxi, Viva, CO2, Erbium, Halo) a few times per year
4) Sculptra injections a few times per year for collagen production with fillers like Juvederm, Restylane, Belotero, Radiesse, and/or Bellafill
5) Thermage/Ultherapy for yearly skin tightening with or without PDO or cone-based Instalift threads for lifting
6) Botox every 2 to 3 months to stop movement lines and prevent lines at rest

Best, Dr. Emer.

Hi Brharris, When not smiling the jelly roll is usually not an issue. Your description of what you don't like is the roll of skin/orbicularis muscle which bulges just below the lower eyelashes when you are smiling. If anyone is promising you that they can botox and skin tighten the jelly roll away, please ask for examples of Before and After photos which actually show this. I have not seen any examples myself, nor do I think it is possible to achieve. I'll try to explain why. Please Google Aegyo Sal. This feature is seen more in younger people. I suspect that when people are younger, their eyeballs are more forward. As they age, their eyeballs sink deeper into their eye sockets which gives them a more deep set eye. If you look at very old people, when they smile, they can't form the jelly roll, because their eyeball is sunken behind the lower rim of the eye socket. So by that logic, the jelly roll is formed by the lower eyelid skin and orbicularis hugging the bottom of the eyeball which is extending past the lower rim of the eye socket. If the eyeball begins to sink into the socket with age, the jelly roll will slowly get smaller. There is an image of Courtney Cox smiling when she had too much filler and she couldn't form any jelly roll/Aegyo Sal. Yet if we look up her photos from the 1980's and 1990's when she was much younger, you can see that her eyeballs were more forward and when she was smiling she also had a Aegyo Sal. Since the bottom edge of the eyeball curvature may be the cause the of the jelly roll, I usually point this anatomic limitation out to my patients who complain of this and also point out that the Aegyo Sal is a desirable feature, and this seems to make them feel better. I also don't want to waste their time and money botoxing the orbicularis so close to the lower eyelid bag which sometimes causes relaxation of the orbicularis which could possibly cause the eyebag below the jelly roll to get bigger because the orbicularis loses muscle tone and the fat bags can bulge even more since the orbicularis is not holding the fat in. Analogy: When a person has a bit of a belly which is protruding out, they can tense their abdominal muscles to make their belly flat. If they relax their muscle the belly will expand outwards. I hope this made some sense and puts a different perspective on your situation. Good luck. Best, Dr. Yang

Hello and thank you for your question. It is always best to see you face to face for a consult and examination however in this case yes botox can be done before or after skin tightening however it's important to leave a gap after botox for at least. week for it to settle. I hope that helps answer your question. Always seek an experienced and qualified medical professional for these treatments. Very best wishes