Botox for under eye wrinkles when smiling before and after

What are under eye wrinkles?

These lines that extend down from the corner of the eye to the cheek are called crows feet . Commonly people think that we can simply treat them with antiwrinkle injections (ie a muscle relaxant). However, it is not as simple as that.

Why do they appear?

These lines appear as we lose elasticity and therefore contractility and ‘spring-back’ of the skin ; also, we lose some of the skeletal support at the cheek bone and mid face through the aging process.  Sun exposure, nutrition and hydration also play a role in this process.

The lines start out as dynamic lines that come from the corner of the eye and appear when we make expressions such as laughing or smiling etc ; as we age they start to extend down towards the cheekbone and beyond and become static ( ie they are there at rest).

Dynamic lines appear when we make expressions.

Static lines appear when we are not making the expression, they are just ‘there’.  

Often people think that treating them with antiwrinkle injections will help and to some extent, antiwrinkle injections are great for this area, especially used in “meso” form>

However when people point to their cheekbones and want us to sort out ‘those lines’ we need to consider a multi modal treatment plan.  By the time the lines become static we need to consider this multi modal approach.

Treatment of Under Eye/ Cheek Wrinkles

Dermal Fillers

1st step, which would give an immediate result would be for some dermal filler placed along the thinning cheek bone and at the front of the face to give back support to the fat pads that give us our youthful facade.

Often people think that placing filler into the face cheeks will automatically make them look like ‘chipmunks’ or ‘fake’ however, if the dermal filler is placed in the correct position and is an adequate amount, it rejuvenates the face in a very natural way. 

Dermal fillers may also be used in the under eye wrinkles themselves, sometimes in a ferning pattern, for increased support.

Antiwrinkle Injections

Antiwrinkle injections should be used in the top and mid part of the eye muscle/crows feet area to stop the muscle contracting and therefore allowing for a bright eyed look..

It may also be injected in a “meso” dose and pattern below the eyes to soften the under eye wrinkles. If placed wrongly in this area, it can lead to a dropped smile or potentially a cheek “shelf” appearance. These 2 issues need to be avoided.

Skinbooster to the lines and area

Skinbooster should be injected to the skin in the under eye area. A minimum of 3 treatments spaced a month apart is recommended.

A skinbooster suitable for under eyes should be used ie brightening and non water attracting.

Energy Based Device treatment of the skin in that area

There are multiple energy based devices that we recommend for this area and they will include, but are not limited to the following:

• Fractional laser (ablative)
• Full field resurfacing
• RF microneedling
• RF skin tightening

Monothread Treatment

3rd step would be to use some monothreads in the area.  Using monothreads we are able to create new collagen and elastin, parts of the extracellular matrix that gives us good skin quality, refined pores, increased contractility, refined texture and improved elasticity and hydration. Like with energy based devices, this process takes several weeks to months before you will see the results.

Maintenance of the area

The upkeep could be attended to with antiwrinkle injections every 3 months and a repeat filler and skinbooster treatment every 6-12 months and mono threads at 6-12 monthly intervals. Energy based device treatments maintenance as advised by your practitioner.

Case Studies

1. Younger Patient with Dynamic Lines Only

This patient had her eyes and small under eye wrinkles treated with antiwrinkle injections only. No other treatments were required.

2. Patient with Static Lines

This patient was an older patient who had never had injectables before. Her main concern was the wrinkles at her eyes. Her other main concern was that we kept her ver natural.

As you can see, we gently reduced the static lines. We did this usinga combination of antiwrinkle injections, and dermal filler to the cheeks and with ferning injections to the lines.

3. Under eye wrinkles and loss of cheek support.

In this case, the patient had a strong orbicularis muscle pulling down her brows. We used antiwrinkle injections for her browlift, crows feet and under eye wrinkles.

She also had a loss of support in her cheeks causing her “crows feet” to extend the whole way down her cheeks. We used multiple mls of dermal filler to replace the cheek support that she had lost.

4. Cheek skin Improvement with Threads

In this case, we used temple fillers for the volume loss and monothreads for improvement in the under eye/cheek area.

RF microneedling was also used in this case.

In general, males love treatments like above due to the natural looking results.

5. Skinbooster and Filler to Fine Lines

In this case skinbooster and tear trough fillers were used for dark circles and under eye wrinkles

6. Skin Tightening Under Eyes

In this case, multiple energy based devices were used for the eye area, including fractional laser and plasma pen. A browlift was performed and skinbooster was injected.

If you would like to make an appointment for under eye wrinkle assessment, please book online or call us on 93315005