Crows feet worsening from Botox - what other options can I use to treat the crows feet area? )Photos)

Hello! My name is Jessica, I am a physician assistant, and one of the providers at Aesthetic Skin - Winnetka & Chicago. This is a great question. If your crow’s feet seem to worsen with Botox, it may be that the surrounding muscles are compensating or that the dosing/placement wasn’t ideal for your anatomy. Other general options include skin-quality–focused treatments such as gentle laser resurfacing, microneedling, chemical peels, or radiofrequency microneedling, which help stimulate collagen and improve fine lines without relying on muscle relaxation. Some people also benefit from small amounts of dermal filler in carefully selected areas to support the skin, though this must be done cautiously to avoid puffiness. Medical-grade topical retinoids and peptides can improve texture over time, but they work gradually. I hope this helps!

Hi, thank you for sharing your concerns and photos. I completely understand how frustrating it can feel when you’re trying to smooth wrinkles and end up feeling like the results are worse, especially around such a delicate area.

From what you describe, a few things could be contributing:

Under-eye bags and volume loss

Botox relaxes the muscles around the eyes, but it does not replace lost volume under the eyes. Sometimes, relaxing the muscles can actually make hollowness or under-eye bags more noticeable.

Injection placement and dosage

The position of the injections matters a lot in this area. If the lowest crows feet injections are too close to the under-eye area, it can affect the natural support of the eyelid and cheek, making bags or wrinkles more apparent.

Other treatment options

Dermal fillers can restore subtle volume under the eyes to smooth the area and support the skin.

Laser resurfacing, radiofrequency, or microneedling can improve fine lines and skin texture without affecting muscle movement.

Skincare with retinoids, antioxidants, and peptides can help improve skin thickness and elasticity over time.

Preventing this next time

Consider avoiding the lowest crows feet injections if that tends to worsen your under-eye area.

A combination approach—targeted Botox for lateral lines + fillers or resurfacing for the under-eye area—often gives more harmonious results.

This area is delicate, and small adjustments can make a big difference. It’s understandable to feel disappointed after multiple attempts, but there are ways to refine the approach so the results are smoother and more natural-looking.

From the provided photo you have skin laxity under the eye. When you affect the adjacent muscle (the crow's feet area) this is making the lax skin more noticeable. You can consider a lower blepharoplasty to remove some of this excess skin which would result in a smoother contour. I've included a video that I hope you find helpful.

Given your comparison is between pre-treatment and post-treatment, as opposed to there being a long interval in between; the meaningful answer is the amount and placement of botulinum toxin - and not directly the impact of ageing on tissues. I suspect that the muscles fibres (of orbicularis oculi) which cause the 'crow's feet' have not been adequately softened. The solution would be a differential combination of toxin and 'microtoxin' in the under-eye (infraorbital) areas. For your reassurance, this is not uncommon and may be addressed fairly easily. Also, for the future, it could be that you avoid the treatment of the lower crow's feet but do consider skin tightening treatments (e.g., laser resurfacing of the skin around the eyes).

Hi, I’m Jessica Cvetic, PA-C, founder of Citrus Aesthetics in San Diego. Thank you for sharing your experience and photos! I completely understand your frustration. Crow’s feet can be tricky because the area around the eyes is delicate, and results depend heavily on technique, placement, and overall facial structure.
If Botox alone isn’t giving you the results you want or is making under-eye hollows more noticeable there are a few options I often consider:
1. Targeted filler for under-eye support
Subtle, precise filler can restore volume to the tear trough, reducing the appearance of wrinkles and bags while supporting the overlying skin.
2. Skin quality improvement
Treatments like microneedling, RF, or laser resurfacing can strengthen the skin, soften fine lines, and improve texture around the eyes so I would recommend doing this prior to neurotoxin treatments to help support the skin integrity, elasticity and strengthen the skin first. Then, later on your neurotoxin results will be much improved!
3. Combination approach
Sometimes a low-dose, carefully placed Botox after filler and skin tightening is the safest way to smooth wrinkles without exaggerating hollows or bags.
At Citrus Aesthetics, I always use my AWQ-10 framework to assess anatomy, muscle movement, and emotional goals. This ensures treatments are both natural-looking and safe, avoiding repeated frustrating results.
A personalized consultation would allow me to review your previous injections and create a plan designed to protect your delicate eye area while achieving smoother, more refreshed results.
Aesthetic treatments should always be discussed with and performed by a trained, licensed, and medically certified aesthetic provider. The recommendations above are for educational purposes only and do not replace an in-person consultation, examination, or personalized medical advice.

Based on one post a photo, the wrinkling of your skin is a combination of issues loss of elastic tissue of lower lid. Skin with muscle activity. Crowfeet is the same issue. Best of virtual concert with would recommend a series of Botox or micro Botox injections along with possible Lower lid, skin, laser, treatment, or chemical peel again best of virtual concert with expect fees to range per session from $1000-$4000.