What type of treatment is best to get rid of these wrinkles that extend diagonally from lower eye to upper cheek?

I had Botox exactly a week ago for what I thought were my crows feet. Although what I know is my crows feet region is a little better, I still have lines that run under my eyes only when I smile to diagonally down my upper cheek. There are 3 prominent lines. I was told by one drs office that this is due to loss of volume in my cheek and botox isn't a good area to inject

Doctor Answers 12

Dermal Fillers for Cheek Lines

Hi Hannah.  The office that told you the lines were from volume loss made a good assessment.  You are very thin and your face has lost collagen and fatty tissue volume.  Our first choice would be Sculptra to replace this lost volume, but other dermal fillers such as Restylane, Perlane and Radiesse are all viable choices as well.  

Laser resurfacing is not going to achieve that which you desire because it cannot replace the kind of volume you have lost and you are correct that Botox works on the crow's feet closer to the sides of the eyes.

Check the photos at the link below for a similar situation.  

Los Angeles Facial Plastic Surgeon
4.3 out of 5 stars 6 reviews

Lines Around the Eyes and Upper Cheek

Typically these larger lines are due to hypertrophy of the musculature underneith as well as some volume loss in the cheeks/temples.  Botox or neuromodulation is a good start but typically will not help the larger lines around the eyes as these are influenced by large muscles that are deeper.  Laser resurfacing and/or radiofrequency or ultrasound devices can help tighten and soften and smoothen the skin.  Filler injection into the mid and lateral cheeks can help lift and superficial injection can help soften the individual.  Overtime, continued neuromodulation treatment will help the muscles around the eyes atrophy and become less prominent and stop any "movement" lines.  Eye creams will not help these larger lines.  Please see a cosmetic dermatologist or plastic surgeon with expertise in filler injection, laser surgery, and eyelid rejuvenation.  I wish you the best of luck, Dr. Emer.

Jason Emer, MD
Los Angeles Dermatologic Surgeon
4.8 out of 5 stars 190 reviews

Treatment of Tear Trough Area (lineas that run diagonally under the eye to the upper cheek)

Though your pictures are tough to judge because they are taken from far away, it looks like you are concerned about the tear trough area hollowing.  This results from the lack of volume between the skin and bone in this sensitive area of our face.  The lack of volume comes from the gradual bone loss that happens as we age and the decrease and the downward descent of the inferior orbital fat pads. This area is amenable to treatment with careful injections of Restylane filler.  The added support and volume resoration with Restylane frequently results in a more youthful and rested appearance.

Tatiana Khrom, MD
New York Dermatologic Surgeon
5.0 out of 5 stars 6 reviews

Cheek lines

You have to distinguish between the lines that the eye muscles make when you squint, and the lines that form when your cheek moves up during a smile.
Botox will only work on the first set of wrinkles. 

Niels C. Krejci, MD
Boston Dermatologist

Upper cheek wrinkles and how to deal

I see in your photo, and recognize this as a dilemma for our patients who come in for Botox crow's feet treatments.  It is true, that it is not a good idea to inject a neurotoxin like Botox lower on your zygomatic portion of your cheek to try and get those wrinkles b/c it may cause sagging or drooping of your entire cheek, giving you the appearance of having had a stroke.  I agree with what your other MD told you that you have some hollowing or volume loss, as we all get with age, in your medial upper cheek area (below your eye).  We all get bone resorption in this region, and along with laxity of our skin from age and sun damage causes sagging and the wrinkles you complain of as well as the nasolabial fold wrinkle around your mouth.  To correct those upper cheek wrinkles, I agree with your other MD, that it is best to place some filler in your upper cheek.  It will also improve the groove under your eye and your nasolabial fold simultaneously.  It is possible to do this treatment with finesse and to have very natural results where no-one can tell you had it done.  That means, not like Brandi Glanville style.   My patients who have never had this treatment done and may be nervous, I recommend starting with just 1ml or 1 small syringe of a hyaluronic acid filler like Voluma to each upper cheek.  That's only 2ml total.  You can return for more in the following weeks if you wish.  For best results, some people do need a little more than that quantity but looking at your photo, I think that would be a good place for you to start.    

Karen Stolman, MD
Sandy Dermatologic Surgeon
5.0 out of 5 stars 7 reviews

Botox and Fillers for wrinkles under eyes

Botox works extremely well for the "crow's feet" which are the wrinkles on the sides of your eyes.  However, they do not work well for the lines that you are describing. That area is the mid-face hollow and would require Voluma or Sculptra to replace the lost volume.  Please consult a board certified dermatologist with a lot of experience with Botox and fillers for the best results.

Michele S. Green, MD
New York Dermatologist
5.0 out of 5 stars 76 reviews

Botox vs. Fillers for Upper Cheek

Thank you for the question. The upper cheek area requires a thoughtful approach and I think you are on the right track. Botox can be used for the crow's feet, just lateral to the corner of the eye. For lines that extend further down the cheek, Botox injections can cause unwanted complications. This is where the muscles that control the smile are located, and Botox here can cause an uneven smile or change your mouth movements. For lines in the upper cheek, volume can be very helpful. This can be achieved with traditional fillers, like Juvederm, deeper and longer lasting fillers, like Voluma or Radiesse, or through Sculptra treatment.

Evan Ransom, MD
Bay Area Facial Plastic Surgeon
4.9 out of 5 stars 110 reviews

Botox first

Perhaps the botox was not injected to address the lateral line extensions & you need to ask your practitioner if they targeted these lines before seeking another treatment.
As these are lines which are visible when you smile - they are dynamic wrinkles & I would recommend botox initially followed by a HA dermal filler to hydrate & volumize with superficial injections in the delicate periocular area.
A course of radiofrequency skin tightening is also effective for this area.

Sabrina Shah-Desai, MS, FRCS
London Oculoplastic Surgeon
5.0 out of 5 stars 63 reviews

Filler for cheeks

Agree that botulinum toxin injection is not a good idea for the lines you are referring to in the lateral cheek area (from smiling).  Dermal filler injection though may be useful.

Mehryar (Ray) Taban, MD, FACS
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 72 reviews

I like to use Botox, fractional radiofrequency resurfacing, or laser resurfacing.

Lines around the eyes are caused by muscle contraction of the muscles circling the eyes. If these are fairly new wrinkles, Botox is often sufficient. If the wrinkles have been there for a while, it may take some type of resurfacing including fractional radiofrequency resurfacing and/or laser resurfacing.

Mark Taylor, MD
Salt Lake City Dermatologic Surgeon
4.2 out of 5 stars 18 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.