Creased corners of eyes after Botox (Photo)

Question

I'm 35 years old been having Botox for 5 years. The problem is I seem to develop creases in the corners of my outer eyes when they are closed after forehead Botox. They look almost pinched.

Anna Chacon, MD, FAAD · Answer

Hi,

Thank you for sharing your photo and explaining what you’re noticing. I can see the subtle creasing at the outer corner when your eyes are closed, and I understand how that “pinched” look can feel concerning—especially when you’ve been doing Botox for years without this issue.

What’s most likely happening is related to muscle balance. When Botox is placed in the forehead (frontalis muscle), it relaxes the upward pull. If the lateral fibers around the eyes (the outer orbicularis oculi muscle) are still active—or compensating—you can sometimes see:

Increased bunching at the outer corners

Small creases when closing the eyes

A slightly “tight” or pinched appearance

This doesn’t mean anything is wrong—it’s more about how the muscles are interacting after treatment. Sometimes when the forehead is smoother, the surrounding muscles become more noticeable in motion or at rest.

Other contributing factors at 35 can include:

Natural skin elasticity changes

Subtle volume shifts in the temple or lateral eye area

Repeated muscle movement patterns over time

The good news is that this is typically a dosing or placement adjustment issue, not a permanent change. Small refinements in how the forehead and lateral eye area are treated can often improve this type of creasing.

Importantly, what you’re describing is dynamic (movement-related), not structural damage. From your photo, the skin quality itself looks healthy.

It’s completely valid to notice small changes after years of treatment—our faces evolve, and sometimes technique needs to evolve with it.

Camille Cash, MD · Answer

Wrinkles at the crow's feet area are commonly treated with Botox.  This can lessen the wrinkles that concern you.  To keep your skin and delicate eye area healthy we always recommend using medical grade skin care products like Transform MD and wearing sunscreen every day.

Creased corners of eyes after Botox (Photo)

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