Smile Lines Under the Eyes Since Teens...any Options?

I now get botox for my crows feet when I smile, but still have the under eye lines. I've had these at LEAST since I was 18 years old. Not much has changed in 10 years. The botox has softened up my face a bit, but the smile lines still drive me nuts-my doctor has never injected the botox below the crows feet area. I've read that fillers can be unsafe around this area and get lumpy. Do I have other options? When I'm not smiling, the lines are nearly invisible.

Doctor Answers 12

Botox for smile lines

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A very, very small amount of Botox (1-2 units per side) may be injected under the eyes, but if your injector is not comfortable with this, I would not do it. Fillers under the eyes are not unsafe in this area as long as its the right filler - never Juvederm - and a very experienced injector.

Lines under the eyes

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BOTOX works great around the eyes, but the lines to which you refer are often also accentuated by the cheek muscles bunching up. We inject a bit of BOTOX under the eyes, just over the big cheek muscles to try to relax them enough to stop reinforcing the under-eye lines that bother you so much. Also, depending on your facial structure, we might want to address the eye hollows with some deeply placed filler, to soften and fill the hollows. This can have a wonderful smoothing effect in just the areas that bother you.

Barry Resnik, MD
Miami Dermatologist

Smile lines and Botox and Laser

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Perhaps a bit more or better injected Botox might be a good solution.  Fillers under the eye can be done without lumpiness usually.  Fillers in the cheek bone area are also useful.  A fractionated CO2 laser treatment is also an excellent option.  

Good luck!

David Alessi, MD
Beverly Hills Facial Plastic Surgeon
4.8 out of 5 stars 18 reviews

Treatment for smile lines under the eyes

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The horizontal lines under the eyes are usually due to contraction of the circular muscle that moves the eyelids, opening and closing the eyes, squinting, etc. - the orbicularis oculi.  Contraction of the same muscle causes crow's feet as well.

1-3 units of Botox injected into that little fold under the eyes should relax the orbicularis and soften the wrinkles.  In addition, you may consider adding a small amount of Restylane into the under eye hollows to make the indentation less.

Emily Altman, MD
Short Hills Dermatologic Surgeon

Botox to fix lines

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Botox does help with the crows feet/pulling of the muscle that cause the lines but placement and amount is the key. More botox does not always equal better results. Since the lines have been there sine your teens, this may be loose/lax skin that is accentuated with smiling or bunching up the skin in that area. Botox that is placed too medially/close to the nasal bridge could cause drooping of the lower eyelid, so I would be cautious with "more botox is better."

Norbert Collins, MD
Redlands Plastic Surgeon

Lower outer eyelid crease

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As you have had these creases since 18, your photograph demonstrates a "scrunching up" of skin over the underlying contracting orbicularis oris muscle that works to close your eyes and squint.  As long as the Botox does not go over the cheek bone, it shouldn't treat the smile muscles. keeping to the side as much as possible, one or two units may soften but not eliminate this muscle action. The exact placement would have to be known by the physician, but even in the most experienced hands, there is a chance that adjacent muscles may be affected creating an undesired action.  You certainly may decie to leave this alone as it is not a wrinkle (not being seen at rest).

Ronald Shelton, MD
Manhattan Dermatologic Surgeon
4.9 out of 5 stars 39 reviews

Botox treatment for "jelly roll" under eye

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A very small amount of Botox can be used under the eye to improve the "jelly roll" that appears with smiling.  Judicious use should occur in patients that experience under eye puffiness when they wake up in the morning.  Very small amounts of volumizing agents may be appropriate in the cheeks or along the bony orbital rim (under eye area) to compliment the muscular relaxation effects of Botox.

Melanie D. Palm, MD - Account Suspended
San Diego Dermatologic Surgeon

Smile Lines Under the Eyes

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Hi QL.  Whomever told you that fillers were inappropriate under the eyes does not know how to inject them.  We think you are a great candidate for Restylane under the eyes.  Your genetics or age have caused you to loe a bit of volume in this area and we would replace that with Restylane.  The product needs to be injected "under the muscle" to avoid lumpiness.

Finally, we may add just a couple of units toward the outer lower eye so soften the line as well.  These two injection techniques together should get you a lot of improvement.  Good luck.

Harold J. Kaplan, MD
Los Angeles Facial Plastic Surgeon
4.4 out of 5 stars 7 reviews

Under eye smile lines

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I think you'd do very well with a syringe of Restylane injected under the eyes.  This would fill in the contour issue and alleviate your concerns.  Botox can be injected at the edge of the eye, in those crinkling areas of the crow's feet, but I prefer filler for the area directly under the lower lid.

Lines under eyes

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I think the easiest thing to do for these lines is not fillers but soem type of resurfacing ie peels or lasers.

Robert Brueck, MD
Fort Myers Plastic Surgeon
4.9 out of 5 stars 69 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.