Botox around the eye -- how much risk? Does this seem like a decent idea based on my issue?

After my lower bleph, fat removal only, I noticed wrinkles around my eyes only when smiling. Also the eye muscles directly under eyes protruded a bit looking like little bags from certain angles. Went to an ocuplastic surgeon yesterday. She said she probably would have done a little pinch with the bleph, but now recommends botox for the wrinkling when smiling and a little around the eye muscle to create a softer transition from muscle to lower eyelid. How much risk is there in trying this?

Doctor Answers 17

Botox after blepharoplasty

Botox can be a useful adjunct to blepharoplasty to improve residual muscle bunching in the lower eyelid and/or wrinkling in the crows feet area.


Indianapolis Plastic Surgeon
4.9 out of 5 stars 16 reviews

BOTOX and Blepharoplasty

Many times I will suggest injections such as BOTOX or fillers is conjunction with eyelid surgery. I find the two go hand in hand. BOTOX will help to decrease the wrinkles around your eyes which, when combined with a Blepharoplasty, will help to give you total correction of the eyelid area. I agree with the Oculoplastic surgeon you consulted with.

Botox for wrinkles around eyes

Thank you for sharing your concerns. It is a good idea to try Botox injections for the wrinkles around your eyes following your blepharoplasty. Botox can also be injected into the orbicularis muscle in order to decrease its thickening when smiling. If this technique is not satisfactory, you can consider having a pinch of skin removed from your lower eyelids. Make sure to have in office evaluation by an experienced injector who also specializes in eyelid surgery. Good luck.

Botox for Crow's Feet around the Eyes

Botox is a fantastic treatment for the small lines around the eyes.  Please consult an experienced professional to avoid any complications.  Best, Dr. Green

How Risky Is BOTOX Around the Eyelid?

Dear Chloeann, Thank you for posting your interesting question. Wrinkles around the eyelids when smiling can be treated with BOTOX. The outer portion of the eyelids is called the crows feet. The lower eyelid muscles can only have very little BOTOX, because too many units injected into this area can lead to drooping of the lower eyelid. Eventually, you may elect to have the lower eyelid skin pinch, which can be performed under local anesthesia. I recommend that you have a consultation with an experienced Board Certified Plastic Surgeon who can examine you and make the best recommendations for treatment. Best wishes, Dr. Richard Swift

Botox around the eye -- how much risk? Does this seem like a decent idea based on my issue?

Hi Chloeann,

Without an in person physical exam or photos is difficult to give you a recommendation.

In my experience there could be 2 reasons that could explain the wrinkles around your lower eyelids.

1. Strong orbicularis muscle under the eyelid. This muscle can look like a "Jolly Rancher" when you squint. The muscle can be attenuated by careful injections of Botox under the eyelid. Not many patients have this problem.

2. The most common problem that I see is that the patient has excess skin under the eyelids due to aging, after fat removal of lower eyelid surgery with no skin removal (Transconjuctival approach), or when the patient smile. The reason for the wrinkles is the excess skin. When the patient smile, the cheeks are elevated and more skin becomes in excess on the lower eyelid area, creating the wrinkles. There are 2 approaches to improve this problem in my experience.

* Remove the excess skin surgically. This means to do an incision on the lower eyelid skin area and remove the excess skin. Many physicians call this a skin pinch excision. This will leave an incision on your lower eyelids. I reserve this to older patients that need a considerable amount of skin to be removed.

* The other alternative is to resurface the skin of the lower eyelid by a chemical peel or laser peel. This procedure also removes and tightens the skin but to a lesser degree than the surgical excision. I prefer this procedure on young patients as it does not give them the surgical incision on the lower eyelids.

Hope this helps,
Dr. Gus Diaz

Gustavo A. Diaz, MD
Charlotte Facial Plastic Surgeon
4.7 out of 5 stars 15 reviews

There is no greater risk with Botox around eyelids than any other location.

There is no greater risk with Botox around eyelids than any other location. When done correctly, Botox can help smooth lateral crows feet and lift the lateral brow. It is not injected into the central lower eyelid.

Botox around eyes

I like the botox for crow's feet or to elevate the lateral brow. I do not inject for wrinkled skin under the eye. If there is loose skin, then pinch of skin removal is probably reasonable.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 24 reviews

Botox effects

Botox is terrific and quite safe in experienced hands for laugh lines of the lateral orbit area.For wrinkles on the eyelid per se ,in general,it  is trickier and riskier and if attempted should be done at very low doses and by only the most experienced physicians,I personally would not leave that to an extender or anyone else besides a very skilled plastic surgeon or cosmetic derm.

Robert Savage, MD (retired)
Wellesley Plastic Surgeon
5.0 out of 5 stars 3 reviews

Botox around the eye -- how much risk? Does this seem like a decent idea based on my issue?

Thank you for your question. This is a more advanced series of injections as improper placement can cause an imbalance in your lower eyelid position, but also can travel too low and cause some of the muscles responsible for smiling to weaken causing your smile to become imbalanced.  See an ASPS board certified plastic surgeon in consultation.  

Nelson Castillo, MD
Atlanta Plastic Surgeon
5.0 out of 5 stars 43 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.