I have wrinkles under my eyes after crow's feet treatment, can anything else be done?

Question

Hello, I came in two weeks ago for my first Botox treatment. My main concern was the eyes specifically crows feet. Overall I'm happy but completely satisfied. Right under my eyes the wrinkles are accentuated. Not sure if its due to shifted/different muscle movement, or just looks this way because they're more in focus. I can tell my cheeks also push up the area, so some wrinkles are just there, however I am wondering if there is something more that can be done? Thank you,

Steven H. Williams, MD · Answer

Hi,Thank you for sharing your question.It is not uncommon that after crow's feet treatment that you may notice more prominent undereye wrinkles. This occurs because the muscle around the eye is is a circular sphincter muscle so when the lateral (outer) parts are paralyzed with Botox, other parts of the muscle, such as the lower portion, may become more active (compensatory activity). A few units of botox in the undereye area can help to soften the appearance of these wrinkles but is considered an advanced technique with its own set of risk factors. I recommend following up with your injector to discuss your concerns and to evaluate whether you are a good candidate for treatment in that area.Hope this helps!

Jonathan Kulbersh, MD · Answer

I appreciate your question and I'm sorry you did not achieve a fully satisfactory result from your initial Botox treatment. It is possible that some additional Botox will improve more of your lines. However, targeting the muscle that forms the lines directly under the eye is not typically recommended because it can result in drooping of one eye to produce an undesirable effect. In some cases, laser resurfacing is a better choice for this area, as it can stimulate some collagen to smooth away the lines without affecting the muscles. I would schedule a follow-up with your doctor for further assessment and treatment recommendations. Always work with a very experienced, board-certified injector to ensure the best possible results with every treatment.

Jason Emer, MD · Answer

There are many things you can do to treat under eye hollows and dark circles. A surgical option to remove skin and/or fat will be the best long term. However, non invasive less downtime options such as fillers, lasers, microneedling/PRP, cosmelan peels and stem cells can all help give some improvement. I suggest. You get a formal consultation to see what is best for you and your goals. Best, Dr. Emer.

Aldo Guerra, MD · Answer

The likely answer is multiple types of treatments needed like fillers, skin care, chemical peels and microneedling. Lasers possibly too, but these yield a longer recovery. Good luck. Dr. Aldo

Tim Sayed, MD, MBA, FACS · Answer

It is possible your injections did not go around into the lower eyelid wrinkles enough to knock out that portion of the orbicularis oculi muscle. Accordingly, you might see a demarcation between where the muscle is weakend (lines are not visible or are faint) and where it is not (lines are same as before). The treatment for this is usually just additional Botox injected to the target lines that are not yet responsive. Some of what you are seeing may just be because now you are scrutinizing things more since you had a treatment. It is normal for there to be some lines of demarcation in most patients between the lid and the cheek. If it's hollowed out there, fillers may help improve the result as well.

Alex Roher, MD · Answer

The wrinkles under the eyes are primarily the result of 2 muscles.  One is the Obicularis Oculi, a muscle that surrounds the eye.  This is the muscle we target when we are decreasing the appearance of the crows feet.  The other muscle is the Quadratus Labii Superioris.  This muscle's two attachements are the zygomatic arch, the cheek bone, and the corner of the mouth.  When you smile both muscles contract.  We can target the Obicularis Oculi with Botox and reduce the appearance of crows feet.  However we are careful not to inadvertently inject Botox into the Quadratus Labii Superioris as this can lead to changes in the appearance of the mouth when smiling, like an incomplete smile when both sides are affected or a asymmetrical smile, leading to a stroke victim appearance, when only one side is affected.  
Flexion of the Quadratus Labii Superioris and Zygomaticus, another major muscle involved in smiling, pushes the superficial fat pads above the muscle up and is the primary cause for the lines below the eyes that you are describing.  
We can add more Botox to the lower portion of the Obicularis Oculi but you will likely always have some lines in this area as a result of the Quadratus Labii Superioris.  And again, it is likely best to avoid targeting this muscle with Botox
Also, when we decrease the appearance of wrinkles in a certain anatomical area, our eye sometimes naturally go to the surrounding wrinkles, enhancing our perception of them.  This may be the case with what you are describing.
I know this was a long answer and an anatomy lesson you didn't ask for, but bottom line, I am happy to see you in our office and add more Botox and see if we can't reduce the appearance of these wrinkles a little more. 
Thank you,Dr. Roher MD

Peterson Pierre, MD · Answer

It's difficult to provide the best advice without photos. Most likely, all you need is a little Botox under the eyes to take care of those residual wrinkles. Alternatively, lasers and fillers can be options as well.

Marek Kacki, MD · Answer

If the lines under your eyes are new and follow Botox injection into the "crow's feet" it clearly indicates too liberal dose of Botox. It is a common result of using too high ("recommended") doses of Botox with subsequent immobility of the area. If that is the case, the lines would be much worse during smile. At this point, there is nothing one could do to reverse Botox but, over time, it's effect dissipates. Make sure you discuss it with your injector. Good luck!

Michele S. Green, MD · Answer

It sounds as if the muscles were affected through the Botox injections.  I would recommend that you return to your treating physician to examine your results.  I would also consider the eMatrix laser for the fine lines under your eyes with three treatments to the under eye area.  Please consult an expert.  Best, Dr. Green

Michael S. Mall, MD · Answer

Thank you for your question.  I believe that since you have had Botox, it could not hurt to return to the injector and request more or express your concerns. My recommendation would be to go through a series of three treatments of Titan eyes. Best

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