Side Effects from Botox for Under Eye Wrinkles?

Question

Does Botox cause thinning of the skin or a reduction in collagen over time? I am considering it for under eye wrinkles.

David Hansen, MD · Answer

Botox is quite safe and poses no problems for use under the eyes for wrinkles at a cost of $300. There is no thinning of the skin nor loss of collagen formation. Botos lasts 3-4 months. Go ahead and do it.

Kenneth D. Steinsapir, MD · Answer

Dear Luci
BOTOX does not cause these issues. However, it is not the best product for reducing the lower eyelid lines. This is because the muscles that are making those lines are also supporting the lower eyelid. When sufficient BOTOX is used to improve the lower eyelid lines, there can be a weakening of this muscle which can cause the lower eyelid to fall. This weakness of the lower eyelid can be bothersome. A great alternative is to fill the lines with Restylane. This product lasts much longer than the BOTOX so it is a great choice.

Otto Joseph Placik, MD · Answer

To the best of my knowledge, there is no reason to suspect that botulinum toxin will cause thinning of the skin or a reduction on collagen in they eye area.

Steven F. Weiner, MD · Answer

The only risk that is different for injecting the undereye wrinkles with Botox is that the injector must be very careful with dosing, placement, and selecting the correct candidate. If you don't have strong enough lower eyelid tension, you can get ectropian, which is when the lower lip everts. Although this will be temporary, it's a problem for several weeks with tearing and possibly drying of the eye. No skin issues can be caused by this injection.

Steven Hacker, MD · Answer

Botox treatments are not typically associated with a change in collagen or thinning of the skin. Botox effects are always temporary. The most common side effect from Botox around the eyes is ptosis and mild temporary bruising.

Marc Cohen, MD (retired) · Answer

Botox does not cause thinning of the skin or reduction of collagen.  In fact because if relaxes the muscles that cause the wrinkle, you tend to have less wrinkles over time as your collagen naturally regenerates. 
While Botox is excellent for crows-feet and brow wrinkles, there needs to be caution when Botox is given directly to the lower eyelid itself.  The muscles in that area are responsible for eye closure and  the pumping away of your natural tears.  If the area is not treated very lightly you could have some temporary side effects like dry eyes or increased tearing.
It is possible to have Botox treatments under the eye, but you should check and be sure that your physician has experience in treating this area because  more skill is needed than for a typical Botox injection.
Hope this helps.

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