Botox hasn't worked to rid majority of crows feet wrinkles and have instead created longer wrinkles to cheeks. (photos)

Question

I have used a new Doctor to have 12 units on each side for crows feet. I know it's only been a week, but in the past it has taken effective within 24-48 hours. This time wrinkles in some areas only lessened slightly and instead now there are a couple of stronger wrinkles going directly from the inside crows feet to my cheek wrinkles. I look worse I believe. I had some cheek wrinkles but nothing like this. I have requested a new appointment but I'm nervous that my Doctor hasn't done a good job.

Brian M. Harmych, MD, FACS · Answer

Since it's only been about a week, I would recommend trying to be patients. Botox takes approximately two weeks to reach maximum effect. If after two weeks you are still not satisfied you should discuss this with your surgeon. From your photos it appears that you may have more advanced facial aging than would be completely resolved with Botox, or other neuromodulators, alone. If these lines on your cheeks are troublesome, you may wish to discuss filler injections such as Juvederm, Restylane, Belotero and others, or a skin resurfacing procedure like laser treatments or chemical peel. Thank you for sharing you photos and questions.Good luck!Dr. Harmych

Joshua L. Fox, MD · Answer

From
your description and from the photos shown, I do not believe this to be an
injector error as much as I believe it to be simply a shortcoming in the
ability of Botox to treat facial rhytids. Your concern is actually a relatively common complaint with patients who
get Botox injected for the treatment of crow’s feet. The Botox relaxes the
muscle that contracts the side of the eye. This muscle in many patients also
helps to raise the cheek with a full smile. By relaxing this muscle to treat
the Crow’s feet, you sometimes change the way the skin wrinkles on the lateral
cheeks and below the eyes with a strong smile.

Those
long cheek wrinkles you show in the photos that are now a little more prominent
are not effectively treated by Botox, and you would benefit from a variety of
other interventions to improve them.

Steven F. Weiner, MD · Answer

These type of extended crows feet meet Botox and filler. You can try placing some Botox a little more laterally but it probably won't do it. 12 units per side is a regular dose so it's not that you were under dosed.

Darryl J. Blinski, MD · Answer

Appears you might need more than just Botox. plus the amount given was very little. Best to seek other in person opinions.

Anthony Perkins, MD · Answer

Thank you for your question!  It does take up to 10 days to see the full result from Botox.  Typically Crow's feet treatments only address the corner of the eyes.  From your pictures it appears that you have lines in your lower eyelid and also your cheeks.  More botox could be added to ease these lines but there is a limit to the improvement that you will see.  The lines along your cheek might be better treated with fillers or Ultherapy.All the best!Dr. Tony PerkinsNYC and NJ

Botox hasn't worked to rid majority of crows feet wrinkles and have instead created longer wrinkles to cheeks. (photos)

Answers (5)

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