43, Hispanic woman, what could be the solution to my crows feet and lid wrinkles? (Photos)

Hello and thank you for your question. If you were to come to me for a consultation in person I would ask how much Xeomin you had received 11 weeks prior and possibly have your injector place more units. If it was your first Xeomin injection it is not uncommon to have to adjust the number of units needed to treat an area. You do appear to have some crow's feet that could be improved still with more neuromodulator. Best of luck to you.

We would need more information. Did the xeomin do ANYTHING? It's possible the dosage wasn't strong enough. If you have set in wrinkles, you may require multiple rounds of treatments before you see any changes. For teh lid sagging, you can consider an upper bleph. I would consider adding along a laser too to help with tightening the eyelid skin.

Before throwing out the baby with the bathwater, my first question here would be whether treatment was performed by an experienced, board certified cosmetic dermatologist injector--rather than at some bargain basement venue-- in order to know that the right concentration and amount of Xeomin was injected and into the right locations. If so, then the use of a low viscosity, cohesive, malleable filler can be used to elevate and smooth the crow's feet and this, too, in order to achieve maximum benefit, should be left to the hands of an experienced physician injector. Hope this helps and best of luck.

Hi! This is Arzu from Dr. Caner Kaçmaz clinic. Thank you for contacting with us. We can recommend you upper and lower blefaroplasty for crow's feet and sagging eyelids.Blepharoplasty is a surgical procedure that involves reshaping the eyelids. It is commonly performed to correct droopy eyelids or remove excess skin, fat, or muscle from the upper or lower eyelids. Blepharoplasty can help improve the appearance of sagging or puffy eyelids, reduce wrinkles, and enhance vision in cases where the drooping eyelids obstruct the field of view. It is typically performed by a plastic surgeon with experience in blefaroplasty surgery. After these operations you will have younger and fresher look.

The eyelids (upper and lower) have extra skin (dermatochalasis) visible. It seems like there is also some sagging (laxity) of brows, but an in-person evaluation will determine this best. Blepharoplasty (upper and lower) as well as a brow lift are likely to help you achieve a result you will be happy with. With your forehead height, you may decide to get a trichophytic brow lift (incision along the hairline) to avoid lifting your hairline higher with an endoscopic browlift. Of note, a trichophytic incision is the same type that is used for hair line lowering procedures and will lower your hairline a little. Alternately, some patients choose to focus on the sides of the eyebrow alone with a lateral browlift.

Based on a photo but without an examination, a combination of an upper and lower lid blepharoplasty and possible subtle lateral brow lift will produce a more natural and better cosmetic result than either one alone.

Keep in mind, that following the advice from a surgeon on this or any other website who proposes to tell you what to do without examining you, physically feeling the tissue, assessing your desired outcome, taking a full medical history, and discussing the pros and cons of the proposed operative procedure with you may not be in your best interest. I would suggest you find a plastic surgeon certified by the American Board of Plastic Surgery and ideally a member of the American Society for Aesthetic Plastic Surgery (ASAPS) that you trust and are comfortable with. You should discuss your concerns with that surgeon in person.

Robert Singer, MD FACS

La Jolla, California

Botox can soften crows feet when done correctly, but will not eliminate permanent wrinkles if present. The best way to prevent facial wrinkles is to use sunscreen and starting at an early age.
For treatment of this area, different approaches can be considered, including a brow lift, upper eyelid, blepharoplasty, skin, resurfacing, using chemical, peels or laser resurfacing.Botox will relax the orbicularis muscle in the area and can soften wrinkles due to tension in the muscle.
I suggest having a few in person, consultations with plastic surgeons in your community.Best,
Mats Hagstrom, MD