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Would you recommend Botox, Juvederm, or both for eye area?

Dr. Dean Kane Q & A. shutterstock_78831334

Q. I was initially considering Botox for my crow’s feet but now I’m thinking that Juvederm may be a better option for the under eye area. Or should I consider both – Botox for the crow’s feet and Juvederm for the under eye area? What would you suggest and how much do you think would be needed? A.  ​​​​While:
  1. Botox for dynamic lines (such as the crows feet), and
  2. ​Fillers for folds (such as tear troughs)
is not 100% true, it is a guideline. ​ ​Dynamic lines are those created by active underlying muscles such as those around the eyes. Botox is great for crows feet relaxation but will not fully erase the etched dermal skin lines and a fine filler such as Silk works well synergistically with Botox at this site. ​Botox for the lines along the lower lid should be used very judiciously. Relaxing these muscles will soften the lines but eventually weaken the lower lid tone, “rounding” the eyelid. ​Separation of the soft tissues and muscles between the cheek and eyelid creates the tear trough. This passive process will not be helped with a muscle relaxer (and may worsen it) but must be filled. Depending on the skill of the injector, different layers of the tissues will fill out the depression of the fold. I have used and recommend deep tear trough filler using Voluma, Perlane or Juvederm Ultra Plus. More superficially, consider Restylane or Juvederm Ultra. Silk that may migrate onto the lower lid skin may create too much swelling and if used must be injected very sparingly. ​ ​With so many choices, it is best to consult with a well experienced, Board Certified Plastic Surgeon, Facial ENT Surgeon, OculoPlastics Eye Surgeon or Dermatologist. ​ ​I hope this has helped. All the best!   ​
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