Why Doesn't Botox Work on my Crows Lines?

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?

Doctor Answers 17

Botox Does Not Work On Crow's Feet Lines That Are Permanent

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Botox works on dynamic Crow's Feet lines that are caused by the movement of the underlying muscle. Botox helps reduce the Crow's Feet that you see when you wince or smile.

After years of muscle pull, sun damage, and aging the Crow's Feet become permanently etched into the skin.

Botox cannot remove these Permanent Crow's Feet that are etched into the skin.

Permanent Crow's Feet are best treated with Combined Laser Resurfacing or facial fillers like Restylane, Juvederm, Perlane oir Sculptra.

Why isn't Botox working?

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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

Harold J. Kaplan, MD
Los Angeles Facial Plastic Surgeon
4.4 out of 5 stars 7 reviews

You need combination treatment

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Botox relaxes the muscles, but your lines and folds are probably etched in your skin. In addition to Botox, you probably need to smooth these folds with fillers like Juvederm. If fillers don't help enough, the next thing to try is laser resufacing. This can be either superficial or deep resurfacing and I use the Contour or Profile laser manufactured by Sciton.

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon

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Botox relaxes the underlying muscle. Fixed wrinkles may not improve.

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It is useful to think of dynamic (from movement or when the muscle functions) and static (at rest) wrinkles or lines. Botox will diminish the function of the underlying muscle and improve those lines or wrinkles that result from the muscle contracting. If thre is a fixed line when the muscle is at rest, then it may not be improved with Botox.

But there are other options that may help. In our youth when our facial muscles function, a line or wrinkle may is created, but it goes away when the muscle returned to rest. As we age, our skin thins, the amount of collagen and elastin in the dermis diminishes, and lines or wrinkles persist even when the underlying muscle is relaxed.

You can improve the quality of the skin and diminish fine lines in a number of ways. An experienced aesthetic surgeon can make recommendations. They may suggest medical grade skin care, light or laser based treatments. There are a number of ways to encourage our skin to replenish what is lost with time and aging.

John E. Gross, MD
Los Angeles Plastic Surgeon

Botox relaxes smaller wrinkles

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Every time we make a movement with the upper face, a crease is made in the skin. When we are young the crease goes away when we relax the muscle. Over time that creases get deep, and are visible even when the muscle is relaxed.

Your creases may be so deep that simply relaxing the muscle isn't enough. It may take months or years of having Botox to keep the muscle relaxed, fillers to replace lost volume, retinoid creams to improve the skin texture, and laser rejuvenation, in order to see the lines go away. It is also important to be sure you are getting enough Botox- if you are getting too little you won't get a fully relaxed muscle. And as soon as you notice movement returning, get your next Botox treatment to prevent the lines from getting deeper.

Jordana S. Gilman, MD
Washington Dermatologic Surgeon

Botox Can Be Combined With Other Cosmetic Procedures to Achieve Aesthetic Goals

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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.

Mark Berkowitz, MD
Sterling Heights Oculoplastic Surgeon
4.8 out of 5 stars 65 reviews

Botox works on dynamic wrinkles

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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

Fillers vs Botox

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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.

Botox for Crows Feet Not Working

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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. 

Chances are good that you're not really a candidate for botox...

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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...

Ken Landow, MD
Las Vegas Dermatologist

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.