Dead eyes after botox - what non filler treatment will help with under eye creases? (Photos)

Question

I received botox for crows feet about two months ago and cant wait for it to wear off. I feel like I have dead eyes and it accentuates the creases under my eyes. Is this normal? Also, is there some type of treatment that can help with the under eye creases without using filler?

Jeffrey H. Spiegel, MD · Answer

Under eye creases are a result of volume loss in the area, otherwise known as tear troughs. Best to start with something that will replenish the volume such as hyaluronic acid Fillers. If you find that you have bulging tissue under the eyes also known as Jellyrolls you can add about one unit of botulinum to the area after assessing the strength of the depressor muscle there. Further along, you may want to consider Lasers as such as erbium to help with discoloration and to tightening of skin.

Anna Chacon, MD, FAAD · Answer

Thank you for sharing your concerns and photos—it helps a lot to understand what you’re experiencing. Feeling like your eyes look “dead” or less expressive after Botox is actually a common experience for some people. Botox relaxes the muscles around the eyes, which softens wrinkles but can also temporarily reduce the natural movement and lift that gives the eyes their brightness. This can make under-eye creases appear more noticeable, especially if the surrounding muscles were compensating before.

Since you’re looking for non-filler options for under-eye creases, there are a few approaches that can help improve texture and smoothness without adding volume:

Laser or radiofrequency resurfacing: Fractional lasers or RF treatments can stimulate collagen production, improving the appearance of fine lines and creases under the eyes.

Microneedling or combined microneedling with PRP: These treatments help remodel the skin and promote collagen, which can subtly smooth creases over time.

Topical retinoids or peptide-rich creams: These can help improve skin thickness and elasticity, reducing the depth of under-eye lines.

Chemical peels (very gentle, under professional guidance): Light resurfacing peels can improve skin texture and fine lines.

It’s important to remember that muscle relaxation from Botox is temporary, so the “dead eye” feeling should gradually improve as the effect wears off, usually around 3–4 months. The key is combining subtle skin-strengthening treatments with time, rather than trying to reverse the Botox itself.

Dead eyes after botox - what non filler treatment will help with under eye creases? (Photos)

Answers (2)

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