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Dr. Dean Kane Q&A – Wrinkles under eyes – would more Botox help or should I try a filler like Sculptra?

shutterstock_86444608Question from Brooklyn, NY: I’m starting to get fine lines and little wrinkles underneath my eyes. I’ve been having Botox for a few years to treat my crows feet and the results are very subtle in fact not that great to be honest. I refrain from having too many units for fear of looking frozen. Would more Botox help or should I try a filler like Sculptura?

 Answer from Dr. Dean Kane, Board Certified Plastic Surgeon from Baltimore:

It is best to be evaluated directly by a well experienced and Board Certified Plastic Surgeon, Facial ENT or Dermatologist for wrinkles around the eyes. ​ ​Botox relaxes the muscles that pull on the skin to create wrinkles. Occasionally and in particular when injected for the radiating lines below the horizontal of the outer eyes and for the creasing of the lower eyelid, side-effects such as swelling or bulging of the eyelid fat pads, lower lid rounding and cheek sag. Botox would therefore not be my first choice in this area. ​ ​Consider a skin tightener such as retinol / Retin-A, TCA peels or laser depending on the thinness and pigmentation of the skin. ​ ​Another option in very skilled hands is the use of Sculptra. For my patients, the results are wonderful and exampled below. ​ ​Traditional hyaluronic acid (HA) gel fillers may cause side-effects such as swelling or a bluish tinting BUT the recent introduction of Restylane Silk maybe your best bet. ​ ​Silk, due to its very tiny particle size and hydration properties will smoothen fine wrinkles and lines. It is on-label around the mouth and lipstick lines and proving very useful around the eyes for crows feet and wrinkle lines as well. ​ ​I hope this has been helpful. All the best!  
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