Why Doesn't Botox Work on my Crows Lines?

Question

I have had five atempts at botox for the crows lines around my eyes, my brow and a very distinct lateral line above my nose (forehead area) but it does not seem to work. My crows feet were slightly lessened, by forehead wrinkles still wrinkled to a lesser amount but still noticable and the vertical line is still very prominent. I have been to two different doctors but the results are still very poor.
Why is this?

Harold J. Kaplan, MD · Answer

There could be a couple reasons why Botox has not had the desired outcome for you.

It is possible that the practitioner is not using the proper dosage. When underdosing, the lines may appear smooth, but still apparent.
If the dosage is correct, it's just possible that your lines are too deep to fix with Botox alone. You may be in need of other services to compliment the Botox results.

If you determine that the Botox dosing is appropriate for you (check with your doctor for the number of units used) then we would recommend checking into the following options.

Dermal fillers such as Restylane or Juvederm.
Laser Resurfacing
Surgical Procedures

Michael Constantin Gartner, DO · Answer

If the wrinkles appear only when you make a facial expression, like smiling, then Botox would be more suitable. Botox treats "dynamic" wrinkles.Fillers would be better for you because the wrinkles are visible even when your face is in a neutral expression. This means that they are "static" wrinkles, and fillers is the right treatment to smooth them away.

Jerome Edelstein, MD · Answer

It is possible that
you need more Botox injected in the crow’s feet to have the effect you want,
and this could be determined at your 2 week followup with your injector. You may also consider other nonsurgical treatments, such as laser based technologies. Injectable fillers can also be administered to the forehead to achieve a smoother contour.

Nelson Lee Novick, MD · Answer

There are two types of crow's feet lines on the sides of the eyes. Those that arise from expression muscle movements (dynamic wrinkles) and those that are present at rest (static wrinkles). Botox and other neuromodulators, such as Dysport and Xeomin, work only on softening overactive muscular movements and hence only can be expected to improve dynamic (movement-related) wrinkles. For static wrinkles (the creases and etching-like marks that arise from years of "folding" our skin while smiling and emoting), we need additional approaches. In general, fillers are used to plump up the creases.

	I have found that performing a Nonsurgical 3D Vectoring Lift in this region first (before using fillers) often provides the necessary projection to soften the wrinkles--which may then be treated with fillers (if still even necessary) to further obliterate them.

	Analogous to the approach used for the Nonsurgical 3D Vectoring Browlift, tiny "threads" or "strains" of a volumizing filler are placed strategically across the crow's feet region, which yield immediate results and also give rise to longer-lasting results via stimulating subsequent neocollagenesis (new native collagen formation) that can lead to further tissue retraction and lifting of the target areas. 

	Consultation with a board certified aesthetic physician experienced in all these techniques is strongly advised to ensure that the best approach or combination of treatments be tailored to your individual needs.

Mark Berkowitz, MD · Answer

I agree with Dr. Shafer. I would add that if you are not ready for surgery speak with your cosmetic surgeon about other less invasive procedures to help diminish these lines. Besides wrinkle fillers, thermage and fractional laser skin resurfacing can help to further diminish these ocular wrinkles. As an Ocular Plastic Surgeon I use a combination of thermage and the Mixto laser in my Sterling Heights, Michigan medical Spa for this goal.

David Shafer, MD, FACS · Answer

This is a great question.  Botox works by paralyzing the underlying muscles, which prevents the formation of wrinkles by preventing the muscle from bunching up the overlying skin.  For mild wrinkles at rest and wrinkles that are only visible when you contract your forehead or orbicularis (the muscle causing crow's feet), Botox is very effective.
For deeper wrinkles that are present even at rest, Botox is less effective.  This is because over years of the constant stress on the skin which causes the wrinkles, the dermis of the skin atrophies (weakens) and a permanent wrinkle is formed.  So, even if the underlying muscle is paralyzed, the skin still has wrinkles from the dermal atrophy.
For these wrinkles, you may need a dermal filler to support the overlying dermis.  Alternatively, you may need surgery to "lift" the forehead and lateral temporal (above the crow's feet) area to smooth out the wrinkles.
I hope this is helpful.  David Shafer, MD New York City

Monika Soni, MD · Answer

Thank you for your question. It is difficult to give you advice without examining you in person.  Most likely the reason Botox is not working on your crow’s feet is that you were not treated with enough units in this area. I recommend having a follow up with your injector to discuss your concerns, and to have a small touch up of Botox. Best of Luck!

Ken Landow, MD · Answer

most likely you need a filler...wrinkles permanently etched in the skin do not respond to botox and are really not candidates for botox...it's not that the botox doesn't work, it's just that the problem you have is well outside of what botox is meant to do...it's not a cure-all...see your doctor and inquire about Juvederm, Restylane or Belotero...

Cameron Rokhsar, MD, FAAD · Answer

If the muscles around your eyes have already formed permanent lines, then Botox can not get rid of these....it can only relax the muscles from forming new ones and redue what you already have. To tackle pre-existing lines, you'll need a filler like Restylane or a laser treatment like Fraxel re:store or re:pair.

	Hope this helps!

Martie Gidon, MD, FRCPC, FAAD · Answer

Botox is used to stop movement but if your wrinkles are apparent at rest, then you also require filler to plump up the lines. Botox and filler complement each other. If you still have lines, you could consider laser treatments to stimulate collagen and thicken the skin so the lines are less visible. Please consult a board certified dermatologist or plastic surgeon who is experienced in all of these treatments.

Why Doesn't Botox Work on my Crows Lines?

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