Freshing Up Those Eyelid Wrinkles

The development of radiating lines, or crow’s feet, around the eye is a stigmata of facial aging. They are the result of near continual muscle action of the sphincter muscle of the eye, known as the orbicularis oculi.

As wrinkle lines form perpendicular to the action of the encircling muscle around the eye, wrinkles develop and radiate outward in a ’sunray’ effect. Treatment of crow’s feet problems is a frequent inquiry. While this request is simple, adequately treating crow’s feet often requires combination therapy.

The main treatment for crow’s feet is Botox injections. Trying to remove these wrinkles without reducing their muscular action will produce disappointing results. Three injections sites for each side will usually suffice, placing them along the lateral orbital rim from below the eyebrow to the body of the zygoma. I never inject below the zygoma for fear of causing paralysis of the upper lip. Most patient’s will have a large vein or two in this area so it is important to avoid these and stay further temporally if necessary, otherwise a nice large bruise will result which will take weeks to go away. A total of 10 to 12 units of Botox per side is usually an adequate dose. For the younger patient without established crow’s feet wrinkles, the use of Botox will be completely preventative if treatments are maintained.

For the older patient who at rest already has established crow’s feet wrinkles, combination therapy will be needed. The combination of muscle weakening (Botox) and skin resurfacing (laser) can make some real dramatic changes over time. Since the eyelids and the surrounding skin is quite thin, it is an area that is particularly responsive to laser resurfacing. For most patients that have a treatment focused on the crow’s feet area alone, we are not talking about deep laser surfacing. Rather I use a light to moderate depth laser resurfacing so that healing occurs quite quickly, usually within three to five days. Light laser resurfacing can be easily and quickly done in the office with an equally uncumbersome and expeditious recovery. The crow’s feet area is pre-treated with Botox during the same visit and then laser resurfaced. To keep the recovery quick, the depth of laser penetration is keep limited. Think about a series of these treatments done twice a year to eventually get the best result.

Botox and light laser resurfacing are the principle methods of treatment for crow’s feet. Botox alone is a great treatment for young patients given its prophylactic effects. When laser resurfacing of the crow’s feet skin is needed, a good long-term result is only possible if the underlying muscle action is controlled.

Dr Barry Eppley, board-certified plastic surgeon of Indianapolis, operates a private practice at Clarian health in Indianapolis. He writes a daily blog on topics and trends in plastic surgery at http://www.exploreplasticsurgery.com.