Lines extending below eye to cheeks when smiling? (photo)

I'm in my 40s and had Botox 3 months ago for crows feet. Not my first time and was satisfied as always. Today I suddenly noticed two lines extending from below my eye into the check on the right side only. They're not in the usual crows feet place for me. What is the cause and what can be done?

Doctor Answers 10

Lines extending below eye to cheeks when smiling?

Thank you for your question. You could do another injection of Botox a little further out on the crows. It is best to look at the line when your face is at rest, if you do have an indentation in that area, you may be a candidate for fillers. Speak with your injector regarding your concern.


Toronto Plastic Surgeon
4.9 out of 5 stars 457 reviews

Cheek wrinkles when smiling

These are best treated with volume-dermal fillers. They can be partially treated with Botox in some cases. Thickening skin which is thin/collagen depleted can be done using the Infini. This is not an easy problem to fix. Please see an expert.

Steven F. Weiner, MD
Panama City Facial Plastic Surgeon
4.7 out of 5 stars 41 reviews

Volume issue?

It might be a volume issue where you have lost some subcutaneous fatty tissue along the cheek region. Best of luck.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 29 reviews

Dark Circles, Eyelid Wrinkles/Bags Treatment -- Restylane or Belotero with Cannulas, Clear+Brilliant, Eclipse Micropen, Viva

lasers, microneedling, botox can all be used to get improvement in this area.  Please see an expert for treatment options.  Best, Dr. Emer.

Jason Emer, MD
Los Angeles Dermatologic Surgeon
4.8 out of 5 stars 190 reviews

Botox does well with lines caused b muscle action

If you can make the lines by using a muscle, like squinting, then they can be relaxed with Botox/Xeomin/Dysport. If the lines are caused by lack of volume and the pushing up, re-draping , of skin wjen moving or smiling them Botox is not the answer but fillers might be. Nest thing to do is have your doctor look at these while face still and then using muscles. 

Jo Herzog, MD
Birmingham Dermatologist
5.0 out of 5 stars 18 reviews

Lines extending below eye to cheeks when smiling?

Thank you for your question.  As we age we may develop fine lines and wrinkles that are not the result of muscle function, such as with Crow's feet, but rather from a loss of volume to the soft tissues in the area.  These facial creases are best treated with placement of dermal fillers to help restore the lost volume and support that gravity and time have caused.  Hope this helps.

Nelson Castillo, MD
Atlanta Plastic Surgeon
4.9 out of 5 stars 65 reviews

Lines around and under the eyes can be corrected with Botox

Lines around and under the eyes can be corrected with Botox. In addition to the traditional placement of Botox for crow's feet, some Botox placed over these accessory lines will correct the problem.

Dr H Karamanoukian

Hratch Karamanoukian, MD, FACS
Buffalo Phlebologist
4.8 out of 5 stars 41 reviews

Muscle Relaxing Agents (e.g. Botox) Can Help Improve Lines Down The Cheek When Smiling

I have been using Botox for cosmetic reasons since 1991 and have been treating crow's feet since then. The problem that you describe is not that uncommon. While there is concern that placement of Botox a bit lower in the crow's feet area toward the actual cheek may affect the ability to smile, I have frankly found that a couple of microdroplets placed just at the border of this region can do the job of softening the lines you describe without affecting the smile, at all. A small amount of filler placed under this region can help, as well, and can often prolong the beneficial effects of the treatment.

Good luck to you. 

Nelson Lee Novick, MD
New York Dermatologic Surgeon
4.9 out of 5 stars 29 reviews

Lines around eyes

As we age we gradually start making other lines which at times cannot be treated with Botox.  Sometimes a combination of Clear and Brilliant, microneedling, or other fillers such as Voluma are necessary to help treat these areas.  An in person consultation is needed to really assess the area.  I love eMatrix for the gentle under eye area to treat these fine lines. Best, Dr. Green

Michele S. Green, MD
New York Dermatologist
5.0 out of 5 stars 76 reviews

Botox for crow's feet.

Thank you for your question. I'm sorry you did not get the result you had hoped for. 

When specific muscles are weakened with botox, others can compensate and become stronger, causing new lines that had not previously been there. Another possibility is that you are only noticing the new lines because you are no longer seeing the lines that were effectively treated. You may need a bit more botox, but it would have to be done very carefully, as botox placed too low in this area can result in smile asymmetry. As always, I recommend that you get treated by a well-trained and experienced dermatologist or plastic surgeon. Best, Dr. Frucht. 

Corey Frucht, MD, PhD
Santa Barbara Dermatologic Surgeon
5.0 out of 5 stars 4 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.