How Effective is Botox for Under Eye Wrinkles?

Under eye wrinkles are a distressing concern to those who have them (and just about all of us eventually get them). One treatment option is Botox. The question is, how effective is Botox for under eye wrinkles?

Before answering this question, we have to understand what causes under eye wrinkles and how Botox works.

What Causes Under Eye Wrinkles

Under eye wrinkles are primarily caused by the combination of both skin looseness and dynamic tension on that skin. In the early stages, dynamic tension on the skin from muscles in the lower eye area plays a bigger role.

With age, skin becomes so weak and lax that the effect of muscle tension becomes less significant. This is because weak skin remains very wrinkled even at rest.

How Botox Works

Botox and its alternatives work by reducing the ability of muscles to contract. When injected near muscles of facial expression, Botox minimizes muscle contraction and the resulting overlying wrinkles.

An important and interesting concept is that many muscles of facial expression are flexed a little bit even when they are not being contracted. So, there is a certain amount of tension that causes overlying wrinkles even at rest.

Botox for Under Eye Wrinkles

Knowing that underlying muscle movement and tension contribute in part to under eye wrinkles, it makes sense that Botox would improve these lines.

And, it does.

How much Botox helps depends on how much muscle forces contribute to the lines. For most people, it’s age dependent. Younger patients see more improvement than older ones. In many patients, Botox is enough to provide very good improvement and may be all that is needed.

Additional Treatments for Under Eye Wrinkles

When Botox is not enough, and in those patients who have such loose skin that Botox won’t help, other treatments may be needed.

The most effective way to tighten lower eyelid skin is arguably laser resurfacing, especially with a CO2 laser. This laser zaps the lower eyelid skin creating a controlled injury. The skin heals firmer and smoother as it heals.

Laser resurfacing helps those with moderate laxity (looseness of the skin). For those with very loose skin, lower eyelid surgery may be the best option.

Chemical peels are another option to tighten skin but generally do not work as well as lasers.

Fillers can also improve lower eyelid wrinkles in two ways. Firstly, lower eyelid hollows can be filled with Restylane. By filling the tear trough deformity, the overlying skin is raised in 3-dimensions tightening it.

Image of Tear Trough

Also, Belotero can be carefully injected into the very fine lines of the lower eyelid skin and fill them.

Downsides of Botox for Under Eye Wrinkles

In terms of medical risks, one potential drawback of injecting Botox for under eye wrinkles is weakness of the lower eyelid margin. A weak lower eyelid margin leads to a slight droop in the edge of the lower eyelid. This is not ideal.

For this reason, only those with a strong lower eyelid should have Botox in this area, and Botox should not be used in those patients who depend on their muscle tension to keep their eyelid in place.

A simple test to evaluate the strength of the lower eyelid margin is one called the snap test. In this test, an injector will gently pinch and pull the lower eyelid away from the eyeball and watch it as it snaps back into place. If it does not snap back, you are probably not be a good candidate.


It doesn’t take many units of Botox to treat the muscle of the lower eyelid, generally about 2 per side. It is often best to treat the crows feet in addition to the lower eyelid muscle which requires 8-15 units per eye.

{ 0 comments… add one }

Leave a Comment

Dr. Osman's Media & Awards