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

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.

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!