Q. I had Botox for the first time 3 weeks ago. My crows feet are gone but I now have thick, deep lines starting under each eye near the nose and sloping downward diagonally towards the edges of my face. These lines may have been there before but the botox means I am now using different muscles in my face so they are more pronounced. They aren’t there when I’m not smiling but when I smile they look horrendous. My botox lady (who has a good reputation) says nothing can really be done. Is she right?
A. Sorry for your troubles! You appear to be a very good observer and intuitive of the problem. The round orbicularis muscle of the eye functions in 3 levels. Outside the boney orbit, called the “orbital orbicularis”; when injected along the lower half of the orbicularis circle, muscle relaxation allows for the expression muscles of the nose, cheek, upper lip and corner of the mouth to modify the lower lid skin. Centrally along the eyelid itself, the “septal” orbicularis press back the eye fat and when relaxed will allow the skin to sag and the bags to become more prominent. The “pre-tarsal” orbicularis stiffens and elevates the lower eyelid. If relaxed, the skin will sag and depending on other eyelid forces, it will evert or invert.
Botox is a injectible muscle relaxer but it is up to the injector to understand the anatomy and function of the muscles to be injected, the amount of Botox to use and what variations can occur as patients are unique as well.
My best recommendation is to allow the 3 months or so for the muscles to return to normal function but there are things you can do for improvement.
- Retin A or TCA peels for skin tightening
- Laser or ThermiSMOOTH for skin tightening
- Botox to the recruitment muscles to counter the effects of the initial Botox
- Filler to stiffen and smoothen the creases created from the loss of lower lid tension with “clotheslining” or draping effect of the skin.
