Botox for crow’s feet on cheeks? Should I try filler instead? (Photo)

Question

This photo is after Botox touch ups. The injector is afraid to isolate the crow’s feet traveling down the cheek because she fears I will lose cheek movement and have a funny smile. The lines traveling down my cheeks are the ones I would like eliminated the most, while the crow’s feet closer to my eyes were not bothersome to me. Any suggestions to pass on to her? Should I try filler instead of Botox? Thanks!

Kristopher Day, MD, FACS · Answer

I hope you don't mind my saying, but this is a very interesting pattern of wrinkle. While not common, this may be related to loss of volume in your cheek, more than a neuromuscular phenomenon, which would be typically treated by botox. I would suggest a consultation with assessment of static and dynamic changes as well as putting these concerns in context of other changes you've noticed in your face overall. I suspect that there may be a good deep cheek filler option for you as well as some surgical alternatives.

Kenneth Hughes, MD · Answer

Botox is traditionally the best starting point for treating dynamic wrinkles such as the forehead and crow's feet area. See a local expert injector with extensive experience and training to ensure optimal results and safety.

Jonathan Kulbersh, MD · Answer

Thank you for your question. If the lines you are referring to are dynamic (appear with certain facial expressions), a neuromodulator like Botox is the best treatment option. The injections can be placed precisely to target the lines without affecting your ability to smile naturally. If the lines are due to volume loss, dermal fillers may be a better solution. However, this treatment also needs to be performed carefully and precisely to ensure a natural, beautiful result. I encourage you to schedule a consultation with a credentialed, highly qualified injector who has the knowledge and experience to produce the best possible result for you.

Nirmal Nathan, MD · Answer

Dear JessLS,

Thank you for your question. Generally, Botox will treat crowsfeet at the lateral eyes caused by muscle movement. A full exam needs to be performed to assess if any of the wrinkles you have are caused by volume loss. If so, filler may also be needed as a combination treatment.

Best regards,

Nirmal R. Nathan, M.D.

o	Certified, American Board of Plastic Surgery
o	Member, American Society of Plastic Surgeons
o	RealSelf Top Doctor

C. Blake Perry, MD · Answer

Additional botox in the inferior lateral canthal area will help with the lines. Filler is not a great option for dynamic wrinkles. If botox is placed correctly, it should not inhibit cheek movements. An in person consultation would be helpful.
Best of luck!

Jason Emer, MD · Answer

you need more botox extended down and higher concentration... but you can use fillers, lasers in the office AND at home peels and rollers (see link).

at home peels like cosmelan, enlighten and aerify along with dermarolling (MTS roller with anteage MD ampules weekly, see link) should be started now to prevent further aging.

For facial rejuvenation,  I would suggest a combination approach of 
1) skin care with products and PRP/microneedling
2) PDT light therapy few times a month with growth factors
3) laser treatments like clear and brilliant regularly and a few times a year Fraxel/halo Viva, Co2/Erbium
4) Sculptra injections a few times a year for collagen production with fillers like juvederm/restylane/belotero/radiesse/bellafill
5) thermage/ultherapy for yearly skin tightening with or without PDO or cone based instalift threads for lifting
6) botox every 2-3 months to stop movement lines and prevent lines at rest
7) deep microneedling RF like Fractora/morpheus8 for tightening of the skin
8) Vascular laser like vbeam/excel V or BBL forever young treatment every quarter (3-4 months)

Best, Dr. Emer.

Richard A. Bartlett, MD · Answer

Dear JessLS, 
Thank you for your question. If the botox used to treat your crow's feet is appropriately injected and placed, it should be an effective form of treatment. Best of luck to you!

Nelson Lee Novick, MD · Answer

In my personal experience, this is quite a common problem. Your injector is quite correct in her hesitation, since Botox placed further down the cheeks may affect the ability to smile naturally. A safer approach would be to use injectable skin boosters, such as Restylane Skinboosters or Viscoderm Hydroboosters or even a diluted coherent filler, such as Belotero Balance, fanned through the region. I have done this many times with excellent results and in fact routinely show my befores and afters of this approach to patients complaining of this issue. Hope this helps and best of luck..

Ramandeep Sidhu, MD · Answer

Thank you for the question and picture. This area can be successfully treated with Botox. Filler on the other hand is not going to address the muscle function but will address the volume loss. I would try to adjust the injection site of botox to give you the results you are looking for.

Camille Cash, MD · Answer

If the injection for the crows feet is done too low it can create an odd appearance around the eye.  You can consider potentially cheek filler to give more support to that area.  You can also consider Morpheus8.  This treatment combines RF technology with microneedling to improve overall skin tone and texture.  I've included a video I hope you find helpful.