Botox crow’s feet

How to get rid of under eye wrinkles?

Reduce laugh lines with Botox

Under eye wrinkles, colloquially known as “laugh lines” or “crow’s feet”, are a sign of age. Because young people do not have under eye wrinkles. Young skin is elastic enough not to let laughter follow laugh lines.

But over the years, this changes: the skin becomes less elastic and under eye wrinkles become clearly visible as crow’s feet. In itself, this is not bad because under eye wrinkles render facial expressions sympathetic. That’s already indicated by their epithet “laugh lines”. After all, laughter is generally associated with positive emotions. But once under eye wrinkles become too obvious and remain constantly visible, many people find them annoying. And then they are looking for remedies. So, how can you get rid of under eye wrinkles?

Botox for under eye wrinkles

My answer to eye wrinkles is Botox. At least in most cases. There are certainly other options that can be used to remove crow’s feet. And towards the end of this post, I’ll address a few. But whenever possible, I revert to Botox as the best treatment for under eye wrinkles. And in this blog article I shall explain why.

These are the topics:

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Laugh lines look sympathetic. Removing them completely with Botox is therefore usually not a good idea.
When spontaneous, sympathetic laugh lines become unwanted crow’s feet

Botox for under eye wrinkles – when?

In numerous instances, unwanted crow’s feet can be quickly and easily removed with Botox. Under eye wrinkles affect the upper third of the face, and this is considered the classic area of application for Botox. But the question is whether their removal is always advisable? Because the eyes are the central part of the face. And the facial expressions of the eyes play a big role in communication. Through the eyes, we not only see, we also “speak” through them. Because our counterpart reads our thoughts, wishes, and worries from our eyes. And the facial expression of the eyes also includes the under eye wrinkles. No sympathetic laugh without laugh lines. Without laugh lines, a laugh doesn’t look genuine. To remove under eye wrinkles, completely and permanently, would therefore be a mistake.

Laugh lines – anatomicalLY

We laugh because we are happy about something. Or when we have a good time. This causes the eye muscle, the orbicularis oculi muscle, to contract. It lies like a ring around the eye. Due to its pull, the characteristic under eye wrinkles are formed. At a young age, this remains inconsequential. Because the skin is then still elastic enough. Even the most frequent and intense laughter does not leave permanent under eye wrinkles. With increasing age, however, the skin loses elasticity and the mimic tension of the muscle leaves a permanent mark. Clearly visible wrinkles form under the eyes. Initially as rather light, superficial laugh lines. Over time, however, they dig deeper and deeper into the skin. And then one day become annoying crow’s feet.

Prevent against crow’s feet

If you want to maintain your youthful appearance for as long as possible, you can prevent crow’s feet with Botox. Depending on the strength of your mimic muscles, an age of late 20s or early 30s is recommended for prophylactic Botox treatment. The facial expressions are not eliminated, but only slightly weakened to reduce the pull on the skin. The formation of laugh lines is then still possible, your sympathetic facial expression will not be impaired. But the development of spontaneous laugh lines towards disturbing, permanent crow’s feet is delayed.

Laugh lines: Yes! — Crows’s feet: No!

Spontaneous laugh lines do not bother anyone. They are only there when you laugh. And then they appear authentic. Crow’s feet, however, which have dug deep into the skin and are always visible, are often perceived as a blemish.

The shape of crow’s feet depends on individual factors, foremost the thickness of the skin and its elasticity. In some people, crow’s feet show up as deep wrinkles, in others they resemble a superficial relief. In addition to crow’s feet, small creases typically appear directly under the eyes. However, they are not crows feet in the strict sense and must be treated separately (more on this below).

Bye Crow’s feet, Hello sleep lines!

Removing crow’s feet can result in the unwelcome effect of rendering fine under eye creases more prominent. The situation is similar with sleep lines: If you inject crow’s feet with Botox, then it can happen that other wrinkles suddenly gain attention. This primarily concerns those wrinkles that are not of mimic origin. Like sleep lines. Sleep lines are vertical lines on the forehead and around the eyes. Since they are not caused by muscle pull, they cannot be treated with Botox. Because this kind of lines is permanent. However, by injecting and smoothing crow’s feet with Botox, they may now appear dominant. Before, they were not noticeable because the crow’s feet drew the attention. Now that Botox has made crow’s feet less noticeable, sleeping lines stand out. In such cases, only dermal filler injections can help.

How to get rid of under eye wrinkles but maintain a sympathetic look

Under eye wrinkles – Allow them dynamically

I treat under eye wrinkles in my patients in such a way that their formation is not completely prevented. As spontaneously occurring laugh lines they are sympathetic, and as such I want to preserve them. What I would like to avoid, on the other hand, is a detached, frozen laugh. A laugh that people rightly turn up their noses at as a “Botox laugh.” It always occurs when Botox is used to literally “inject away” crow’s feet, thereby completely paralysing the mimic muscle.

Botox for crow’s feet only moderately

Therefore, I advise my patients to use Botox against under eye wrinkles only moderately. The goal I am pursuing is to be able to dynamically evoke laugh lines around the eyes. This means that the laugh lines only become visible when you laugh. Otherwise, not. The skin is smooth when looking neutral. But when laughing, it wrinkles around the eyes. That’s how it looks natural. I’m big on maintaining natural-looking wrinkles on the face for a sympathetic facial expression, rather than eliminating them at all costs. In my opinion, this is an important factor that is often overlooked.

Botox crow’s feet – standard scheme

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Standard scheme Botox crow’s feet:
3 injection points around the corner of the eye

The standard scheme for crow’s feet Botox treatment, marked in black in the picture, provides for three injection points around the corner of the eye. And I usually stick to that scheme. When a patient comes to me for treatment for the first time, I even dose a little below the standard recommendation. Since I do not yet know the intricacies of his anatomy, I can only estimate approximately how strong the Botox will work. And I’d rather be wrong “downwards” than “upwards”.

Reduce under eye wrinkles in 2 Steps

If the dosage of Botox was too low for an optimal result and crow’s feet continue to appear, I can always add more during the follow-up appointment. Conversely, there would be nothing to be done about too much Botox. Once injected, it will be there for several months. Therefore, I prefer the cautious approach and dose low at first.

In addition, too much Botox in this important region of the face can also have undesirable consequences, which can be avoided by careful dosing. Such as drooping of the lower eyelid. Or, if the toxin diffuses too strongly toward the eyeball, temporary double vision (diplopia). Both are unpleasant and cannot be remedied. Instead, it would be necessary to wait until the effect of the toxin wore off.

Fine creases under the eyes

I have already addressed the problem of small creases under the eyes above. The dense mesh of very fine lines, which become more and more visible over the years as fine ripples in the skin. They show up more strongly in fair-skinned, blue-eyed and red-haired or blond people, triggered by frequent blinking in bright light and strong sunlight. As with other wrinkles, other factors contribute to their formation, foremost the age-related loss of elasticity. The same applies to environmental influences such as wind, nicotine, or alcohol.

Micro-Botox against Creases

Although under eye creases are also caused by muscle tension, the classic Botox injection is not suitable against them. The region under the lower eyelid is too thin and sensitive for this. Instead, I use a technique called Micro-Botox to treat this area. Micro-Botox is diluted more than usual and then injected into the overlying skin rather than into the muscle. In this way, a subtle smoothing of these fine wrinkles under the eyes can be achieved without provoking undesirable consequences in this sensitive zone.

Alternatively, wrinkles could also be treated with a low viscosity dermal filler, a so-called “skin booster”. Here, too, only superficial injections are made into the skin.

Prices for Crow’s feet Botox treatment at LIPS and SKIN

How much does Botox for under eye wrinkles cost?

Botox for under eye wrinkles costs €280-€350 in my practice in Munich. This price range is indicative, actual treatments are billed according to the German Medical Fee Schedule (GOÄ). If the above standard scheme for eye wrinkles is applied, then the indicative price is quite reliable, however. Since one vial with 50 units of toxin will likely not be used up for the crow’s feet treatment alone, it is a good idea to treat forehead lines or glabella in the same session.

What other methods exist to treat crow’s feet wrinkles?

Alternative Treatment options

Fillers for crow’s feet

An alternative to crow’s feet Botox treatment is the augmentation with dermal filler. Dermal filler treatment is similarly uncomplicated and just as effective. In the case of a proportion of static wrinkles and sagging tissue, a filler treatment will probably achieve even better results than Botox. In the case of crow’s feet that are already very deeply ingrained in the skin, filler augmentation thus becomes the remedy of choice. However, the price of dermal filler treatment is higher than Botox at €450-€550. (Price range indicative, actual billing according to the rules of GOÄ).

Thread lift of crow’s feet

Smoothing crow’s feet with PDO threads is another option, and often just as effective. In a thread lift, 2 to 3 absorbable sutures are inserted under the skin. The procedure takes place under local anaesthesia. On the one hand, the subtle mechanical pull of the threads lifts the tissue and can thus smooth crow’s feet. On the other hand, the threads stimulate collagen synthesis and thereby rejuvenate the tissue. A thread lift therefore has a regenerative effect. However, the price of thread lifting of crow’s feet is about €500-€700, which is higher than the cost of Botox. (Price range indicative, actual billing according to the rules of GOÄ).

Microneedling, Chemical Peel, Laser

As long as under eye wrinkles are rather light, several additional treatment options come into play. Among them chemical peel or laser. Moreover, a microneedling can also remove incipient crow’s feet. As standalone treatment or with PRP (vampire lift). However, for good results, all of these procedures require multiple sessions, typically 3 to 5 times, 4 to 6 weeks apart.

Attractive at every age

LIPS and SKIN Aesthetic Medicine

Eva Maria Strobl, MD
Herzog-Heinrich-Strasse 34
80336 Munich