Skin fold under eye with smiling - will botox help or worsen? (photos)

Had crows feet as well as creases/folds underneath my eyes with smiling. Received botox to crows feet and a little to under eye area. Now 1.5 weeks later, crows feet are gone, lines under left eye are improved, but there is a fold/roll of skin that forms under my right eye and seems more noticeable than pre-botox. Fold is not present without smiling. Almost seems like fold occurs when skin is being pushed upward with a smile. Will botox help? If not, what will?

Doctor Answers 11

Botox for under eye roll when smiling

The roll that appears under your eye when you're smiling is most likely due to a thickening of the muscle (hypertrophic Orbicularis Oculi muscle). A small amount of Botox, 2 units to start with, injected into the fold should take care of it. I would recommend a follow up appointment with your doctor.


Cleveland Dermatologic Surgeon
5.0 out of 5 stars 13 reviews

Lines under the Eyes

Hello!  Thank you for your question, and for sharing your pictures. Under eye wrinkles are a very common concern. The reason for this is simple:  Generally speaking, there are 3 things which drive the aging process around the eye:  

(1) muscle contraction can cause expression lines to be come etched into the skin.  

(2) volume loss along the cheek bones can lead to hollowing under the eyes, and  

(3) The skin itself becomes weak and  stretchy with time due to loss of collagen.  

Underneath the eye all 3 of these things come together to create the perfect storm.In my experience, the best results come when you address all 3 of these problems one at a time.  Botox can be used directly under the eye.  It will help some, approximately 10-15%, but do not expect a miraculous change from it as the muscular contribution to these lines is a relatively small.  Filler can also be used, especially around the outside edge of the eye (I generally place very little to no filler directly under the eye as this is an area where it is difficult to get a smooth, natural appearing result), and by lifting the skin, can help "fill out" some of these lines as well.  However, because you cannot place filler above the bone that surrounds the eye socket, there is a limit to how much benefit you can get from filler in that area.  The third thing you can do is to stimulate the skin to grow more collagen, so that has the ability to stand up to gravity better, which will reduce those lines.  There are many treatments which increase collagen in the skin, but they have one thing in common:  skin will regrow collagen, but only when it thinks it has been wounded.  Therefore, all collagen increasing treatments are based on the concept of the controlled wound.  You do something to the skin, create some small amount of damage, and the skin responds by growing more collagen.  Lasers use heat to create this controlled wound, peels use acids, and microneedling uses physical puncture, however, they are all "getting at" the same healing response.   For under eye line such as yours, I generally recommend Botox, followed by a series of collagen building treatments such as microneedling, which can go all the way to the lash line. The combination of muscle control and skin strengthening will be what helps you the most. I do not see a great need for filler based on the pictures you provided. I hope this helps, and good luck!

Skin fold under eye with smiling - will botox help or worsen?

Hi there, little drop more of Botox under your right eye could help you to decrease that jelly roll. I would also recommend Thermi- Smooth  and better skin care. Seek the help of a board certified dermatologist for a consult. Good luck Dr. Downie.

Jeanine B. Downie, MD
Montclair Dermatologic Surgeon
5.0 out of 5 stars 3 reviews

Options for lower eyelid wrinkles

Dear Ir 635:Initially, Botox may reduce some minor dynamic wrinkle lines but it also relaxes the muscles which close the lower eyelid and push back the fat pockets. Better options are skin firming with Sculptra and skin tightening with retinoids, and various lasers or ThermiSMOOTH. Consult with a very experienced and knowledgeable, Board Certified Plastic Surgeon for a in-person evaluation. All the best!

Dean P. Kane, MD, FACS
Baltimore Plastic Surgeon
4.8 out of 5 stars 70 reviews

Botox under eye

Usually  in this area I inject a small amount of Botox around  2 units. But your injector needs to make sure you have adequate support of the lower eyelid or it can cause the eyelid to droop or sag.

Byron A. Long, MD
Marietta Oculoplastic Surgeon
5.0 out of 5 stars 3 reviews

Dark Circles, Eyelid Wrinkles/Bags Treatment -- Restylane or Belotero with Cannulas, Clear+Brilliant, Eclipse Micropen, Viva

Botox, Lasers, microneedling/PRP all do well to treat this area. I suggest you see an expert for treatment options. Dr. Emer.

Jason Emer, MD
Los Angeles Dermatologic Surgeon
4.9 out of 5 stars 165 reviews

Lines under eyes

Hello, and thanks for your question and photos.You may benefit from a small amount of Botox placed directly under the eye. I recommend an in-person consultation with a well-trained dermatologist or plastic surgeon. Best of luck, Dr. Frucht.  

Corey Frucht, MD, PhD
Santa Barbara Dermatologic Surgeon
5.0 out of 5 stars 4 reviews

Botox Works Well For "Donut Rolls" Under The Eyes

From the photo it appears that you have the so-called "donut" roll under the eyes with smiling. Actually, it is muscular hypertrophy and typically responds well to a microdroplet of Botox placed directly into the "belly" of the muscle. Since this a region for only advanced injectors with experience, it would be wise to make certain that you undergo treatment by a board certified aesthetic physician with particular experience in injecting the undereye region. Best of luckj.

Nelson Lee Novick, MD
New York Dermatologic Surgeon
4.8 out of 5 stars 23 reviews

Botox under eyelids

i would not recommend Botox under the eyelids as this may cause a drop; If you have deep tear troughs, then a filler (Restylane Silk for example) may help. If not, then consider a lower lid blepharoplasty.

G. Richard Cohen, MD
Boca Raton Ophthalmologist

Skin fold under eye after Botox

Hi Ir635,
In my experience this fold can occur after Botox of the crows feet and/or under-eye area and will not improve with more units under the eye. I've had it happen to myself and do not like it. It happens due to weakening parts of the circular eye muscle. Give it time and it will improve. And then next time skip the injection directly under the eye and see if that helps. Good luck!

Elizabeth Geddes-Bruce, MD, MS
Austin Dermatologic Surgeon
5.0 out of 5 stars 3 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.