Updated: Jan 6, 2021
If you are bothered by lines around your eyes, botulinum toxin may be able to treat them.
What is Botulinum Toxin?
Botulinum toxin is a neurotoxin that has been prepared to relax or fully paralyze specific muscles they are injected into. How does the paralysis happen? The muscle contracting transmitters can't get out of their uber to get to the muscle, so they go back home. This causes no damage to any structures of the nervous or musculoskeletal system.
Botox, Dysport, Xeomin, and Jeuveau are FDA approved Botulinum Toxin Type A brands for cosmetic indication to treat the glabellar complex. Just like Kleenex, we often refer to the treatment as the brand name, Botox. "I'm going to get Botox." "Pass me the Kleenex." What we mean to say is, "Pass me the tissue," or, "I'm going to get Botulinum Toxin type A injected to relax specific muscles."
How Does Tox Work For Crows Feet?
Botox relaxes muscles. Botox does not remove lines directly, but stops skin from creasing, which softens the wrinkles. For example, if I crease a bedsheet every day for years, a tight crease will form. If I iron the sheet, but I don't stop creasing the sheet, the crease will not go away because the sheet keeps getting creased. We need to stop creasing the sheet. This is what Botox does.
Botulinum toxin paralyzes or softens the muscles that create fine lines in areas such as around the eyes. The muscle around the eyes is the orbicularis oculi muscle. It contracts inward, forming creases on the side of the eye.
Will My Line(s)/Wrinkles Go Away?
If your skin only creases when you contract the muscles, Botox will relax the muscles, stopping the creases made by those muscles. Lines only visible by contracting the muscles are called dynamic lines. Lines visible at all times when the muscles are fully relaxed are called static lines. Static lines will soften with time depending on a variety of factors.
If your skin has static lines, your sheet (or skin) will need some ironing treatments (skin resurfacing ie. retinol, chemical peels, lasers, microneedling), in addition to stopping the creasing (Botox). The quality of your skin (younger, older, sun-damaged, sun protected), and how long the crease has been present will determine how long it will take for the line to go away. Some wrinkles or deep creases may never go away. This is why preventative Botox, or Baby Botox, is on the rise. It stops the creasing before it happens. If the line is present at rest, the treatment is no longer preventative.
What Are The Risks of Botox Around The Eyes?
Injection Site Reactions
Injection site reactions are the most common risk. This includes bruising, swelling, minor pain, and sensitivity. Bruising is more common around the eyes. Swelling does not commonly happen around the eyes. Pain is very limited, though sometimes I compare the pain to plucking a thick hair in the area getting treated.
Blurred vision is an extremely rare risk that can occur if tox is injected too quickly around the eyes, or if there is extreme weakening of the muscles in this area already. If the tox is injected towards the eye very quickly, it may affect the extra-ocular eye muscles, or the muscles that help the eye move. This can cause blurred vision. This risk is incredibly rare, and can be decreased by identifying predisposed weak eye muscles, placing a finger between the eye and the injection, injecting away, not towards, the eye. With this said, many providers inject quickly and towards the eye and this risk does not happen. It takes a very rare candidate to have this occur.
We contract the eye muscle when we smile. There are three ways we may notice a difference in our smile with crows feet tox. One is when the corner of our eyebrow does not pull down as much. This is also a desired effect called a brow lift. Another is from greater space or height of the skin to the side of the eye. When the eye muscle cannot contract towards itself, it may have more space or height. The last way this can affect our smile, is if the tox is placed too low to the side of the eye, impacting the cheek. This may result in a 'dropped cheek' where the cheek stays low instead of lifting. You can see what this looks like by searching up Simon Cowell Crows Feet. His crows feet are lower around his eyes. A strong dose in the lower eye or cheek area can drop the cheek. This risk is also rare.
How Much Is Botox For Crows Feet Or Around The Eyes?
Some clinics charge by unit, while some clinics charge by area.
Most places charge by unit, and the price per unit or per area will vary based on the specialty, location, and many other factors.
Around the eyes, Botox is FDA approved to last 3-4 months at a dose of 24 units (12 per eye). Dysport, Xeomin, and Jeuveau can also be used off label for the crows feet. Off label means there are no FDA approved studies. The FDA approval process is a rigorous, expensive, time consuming process, and most of the areas toxin treats are not FDA approved. There are thousands of studies proving safety and efficacy of different botulinum toxin brands in various areas of the face and body.
Most men and some women with strong muscles will need more units. 30-40 units of Botox is not uncommon around the eyes alone. The stronger the muscle is, the more units it will require.
What Should I Do Before My Crows Feet Botox Appointment (Pre Care)?
The area around the eyes has a slightly higher risk to bruise, so avoiding blood thinners to prevent the risk of bruising is a good idea. Common blood thinners are alcohol, aspirin (and NSAIDs), fish oil, gingko biloba, ginseng, and garlic. If you are on a prescription blood thinner, it is possible to have injections as long as your primary care physician gives the okay and you are not in critical health.
If you have high anxiety or are really nervous, you may have a history of fainting with injectables, like getting needle pokes or giving blood. This is called vasovagal syncope. To avoid fainting, make sure you have eaten before the appointment, avoid coffee, and be hydrated. Communicate your fainting history to your provider. It helps to talk during the treatment, or be distracted. To avoid fainting, make sure you do not hold your breath. Relax your upper body. If you feel yourself about to faint, squeeze your abdominal muscles, and tell your provider so they can lay you down.
If you love to workout, plan your workout before your appointment. Sweating profusely is discouraged for the rest of the day, or 24 hours after tox.
What Will My Crows Feet Appointment Be Like?
First your provider will assess your concern. They will estimate the amount of units and check your medical history. You should disclose any medical conditions, allergies, medications, and current pregnancy or breastfeeding information. The only people who should not get Botox are those who are pregnant, breastfeeding, severely or acutely ill, or who have some muscular weakness disorders.
They should take baseline pictures in consistent lighting of your muscles relaxed and contracted to store in your chart. They should educate you on the risks of the procedure. They should assess the characteristics of your muscles.
The skin around your eyes will be cleaned, and the product will be injected in 3-5 injection sites (or less) per side. It will take a total of 30 seconds to 3 minutes to inject.
What Do Botox Injections Feel Like Around The Eyes?
The injection feels like a tiny pinch, maybe equivalent to plucking a thick hair in the area being injected. You may or may not feel the fluid being injected. It has the consistency of water. It may or may not be cold. You may or may not feel a little bit of blood from this area after the injection. It is common and normal for blood to come out of an injection site, though the injection site may also not bleed.
You may feel like the treatment is working immediately, but that is just the presence of the fluid in the tissue. It takes a minimum of hours, usually a few days to begin seeing effects.
What Should I Avoid After My Treatment?
There were general rules created when tox was developed for cosmetic use. These are "do not sweat, workout, or use a sauna for 24 hours after, do not lay down for 6 hours after, and do not touch the area treated for an hour." You can also contract the muscles treated more after the treatment to help the tox kick in faster.
What Does Botox Feel Like Kicked In Around The Eyes?
Squeeze your hand tight. This is what your muscles do without Botox. Move your hand a little bit, but don't squeeze it tight. This is what Botox feels like. You won't be able to squeeze the muscles of the area tightly. You may be able to move them, but they will not squeeze tightly.
All toxin products take ten days to fully kick in. The strength is the greatest after kicking in, and will wear off with each passing week. For some people, you may feel a little tight in the beginning. The tightness will soften with the passing weeks. If you can move the muscles in the beginning (at day 10) they will be able to move more with the passing weeks.
What To Expect From My Treatment
If you express your goals and expectations to your provider, your provider should be able to educate you on if those goals and expectations are realistic or not, and what they recommend.
If you want your lines gone, you will need to fully freeze the muscles. This does not mean you will not be able to make expressions. The expressions that utilize the muscle surrounding the eye will soften. Fully paralyzing the muscle may not fully get rid of your lines. For example, if your sheet has a crease and Botox keeps the sheet flat, you may need ironing treatments to help soften the crease. Some creases may never fully go away.
If you want to be able to move the muscles that are treated, your treatment will not last as long. If 24 units in around the eyes lasts 3-4 months, less units will last less time.
If you move too much for your liking before the three month mark, it does mean you need more units. More units will last longer. A fully frozen muscle for 3-4 months is not a realistic expectation. The effects of the treatment continually soften past the two week mark. The muscle will slowly regain movement and strength between the treatment duration.
Which Tox Product or Brand Should I Pick?
I could make a whole blog post on this topic alone. Early in my injectable career, I set out to compare every single publication on all types of toxin for cosmetic use for efficacy. I spent over half a year trying to compare all of the studies, and learned that it was impossible to compare. The indicators of efficacy such as onset, duration, or improvement in lines are defined differently in every study. Most studies are funded by pharmaceutical companies that profit off the product and have bias. There can be flaws found in every single study, or findings can be disputed. The points used in-vitro to support a product as 'the best' are also not necessarily indicative of product efficiency. I could ramble on end about this topic.
Here's my advice. I feel every patient should at some point try every product type. All of the products are so incredibly similar. Every patient has a different goal and different opinions on what they feel is the best outcome for them. Keep in mind placement of injection is greatly responsible for patient satisfaction. Placement is directly influenced by the patient's communicated expectations and feedback. Providers are also heavily influenced by the price they get the product for and politics associated with the companies. If you feel too pressured by a provider to pick a specific product, they are not the right provider for you.
Try whichever product makes you feel the most secure. Try the product the injector recommends for you. Try a different product if you weren't happy with the previous treatment (and communicate your concerns to the provider to alter their injection placement if not previously satisfied).
Am I A Good Candidate for Botox Around My Eyes For Crows Feet?
You are not a candidate if you have some rare muscular disorders, expect tox to remove all of your lines, or do not accept the risks that come with the injection. You are also not a good candidate if you expect absolute perfection with your first treatment. Your first treatment is a learning experience, and even though this is a very simple area, you may need to communicate to your provider if you need more units or if the area felt too tight. It is also very possible to not enjoy what tox feels like, and will take trying the treatment with the right provider to learn if this is the right treatment for you.
A good candidate is someone who is looking to soften the lines around their eyes. They may have static or dynamic lines. They understand and consent to the risks of injection. They do not expect lines to fully eradicate immediately after tox kicks in. They are able to be local to the clinic ten days to two weeks later in case they need a touch up.
If you live in Southern California, specifically Los Angeles, Orange County, or San Diego, schedule to see Jasmin in Costa Mesa, California for Botulinum Toxin Crow's Feet. Consultations are free.