Should There Be Wrinkles After Botox?

I had Botox injected into my crow's feet 5 days ago. It's certainly done the job on the deep lines I had around the corners of my eyes. However, I'm sure my eyes now look extra wrinkly underneath, which isn't what I intended. Does this happen a lot and is there a remedy for it?

Doctor Answers 15

Botox can cause new wrinkles if not done correctly.

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In Manhattan, we have seen the picture you describe a number of times.  If Botox is injected too close to the eyelis or in too high dose, the untreated muscles in your lower lids become extra active as a reaction, and form new or deeper wrinkles.  Will go away in 3 or 4 months.

Manhattan Plastic Surgeon

Wrinkle under eyes

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Precise small quantity of Botox or Dysport can be used in outer parts of lower eyes to minimize the appearance of  wrinkles. 

New eyelid wrinkles after Botox

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By changing the pattern of the contracture of the muscle you may notice a different wrinkling pattern under the eyes when smiling.  A small amount of botox in this zone usually takes care of this problem.  

Jeffrey Zwiren, MD
Atlanta Plastic Surgeon
4.5 out of 5 stars 20 reviews

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Wrinkles after Botox

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Thanks for your question.  First, I would wait a full two weeks to assess the results of your initial treatment and then return to your physician injector to discuss any concerns.  Without a picture it is difficult to fully evaluate but it sounds as if the Botox has begun to work appropriately on the lateral orbicularis muscle and now you may be noticing some wrinkling of the lower lid skin which could be from a number of different etiologies and may be  treated with slightly more Botox / Xeomin /Dysport, lower lid blepharoplasty or may be best treated with laser resurfacing.  These options will be best discussed with  your injector who should be able to ascertain which will best resolve your concerns.

Best Regards,

Jacque P. LeBeau, MD

Jacque P. LeBeau, MD
Pensacola Facial Plastic Surgeon

Wrinkles and Botox

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You can have Botox injected underneath the eyes to help with under eye wrinkles, which in your case are likely more noticeable to you now since the crows feet have been softened from your treatment with Botox.

Jeffrey W. Hall, MD
Austin Plastic Surgeon
4.4 out of 5 stars 19 reviews

Crow's feet are caused by eye AND mouth muscles

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When Botox is injected into the crow's feet, it is injected into the squinting muscles.

However, Crow's feet can sometimes be caused by smiling muscles. It sounds as if this is your problem. The issue is we can't weaken your smiling muscles because if we do, you may look like you've had a stroke.

Otto Joseph Placik, MD
Chicago Plastic Surgeon
4.9 out of 5 stars 86 reviews

Hang in there

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Botox will take 7 to 21 days to reach maximum results. After that time period if you still see minimal change the "static" lines will likely be better served by fractionated or full ablative laser resurfacing. The best option is to treat with Botox wait 2 weeks then use a laser to brush over the remianing lines.

Shawn Allen, MD
Boulder Dermatologist

Botox for Crows Feet

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I think using Botox for crows feet area wrinkles is one of the most tricky applications. Occasionally, as you noticed, the area on the sides gets relaxed, and the wrinkles go away, but the area underneath can actually get worse, or seem worse.
Sometimes it needs additional Botox or Microbotox injection underneath the eyes, which can make it a lot better. Sometimes, when the patients smile, we notice the cheek really rising up and making this area appear more wrinkled. In these cases, less Botox will actually make it look better, and this is something to consider when injecting. Finally, under eye area resurfacing with Active FX or similar fractional CO2 lasers will help to build collagen, improve tissue elasticity and strength, and will also help it look better.

Stella Desyatnikova, MD
Seattle Facial Plastic Surgeon

Botox may not be the answer

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Botox is one of my favorite tools to improve aging skin without the use of risky surgery, but it is not for every patient. As the skin around and under the eyes ages, laxity can be more of an issue than crow's feet. If the doctor does not have the experience to recognize the situation, Botox can disappoint the patient. As I always say: the experience and judgment of the doctor is more a predictor of success than the product whether it be Botox, filler or a laser. Lax skin that wrinkles more after Botox usually needs laser. The new fractional CO2 devices being the best, but Fraxel re:store has a place here too.

Mary P. Lupo, MD
New Orleans Dermatologist
5.0 out of 5 stars 18 reviews

Wrinkles from Botox under eyes

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Yes this can happen if not properly injected. Make sure when choosing someone to inject botox or fillers that they have advanced training and have been working with Botox and fillers for a long time.

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.