Botox Under Eyes

Woman smiling and pointing at her eye for post about Botox uses in the under eyes area.

Medically Reviewed by Arash Akhavan, MD, FAAD

 

 

Botox in New York City is widely known for its effectiveness in treating crow’s feet, the fine lines that appear on the sides of the eyes, and that is one of the three FDA-cleared areas for Botox injections. However, one of the most common questions we receive from our patients at The Dermatology and Laser Group is if Botox can be used under the eyes. Patients often ask about its potential to address issues such as wrinkles, crepey skin, dark circles, and tear troughs. While Botox can be beneficial in this area in some cases, there are significant limitations to what it can achieve.

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Botox Benefits Under The Eyes

There are benefits to Botox injections under the eyes only when addressing dynamic wrinkles—those that appear with movement, such as smiling or squinting. This is most effective for patients whose crow’s feet extend into the under-eye area. Because the skin and muscle layers in this region are very thin, careful evaluation is essential before considering Botox here.

The Snap Test

Before injecting Botox under the eyes, we perform a snap test to evaluate the skin’s elasticity. During this test, the skin under the eye is gently pulled away from the face and released. If the skin snaps back into place quickly, this indicates good elasticity and means the area is more likely to respond well to Botox.

For patients with a negative snap test, where the skin does not snap back immediately and instead stays tented, Botox under the eyes is not recommended. This lack of elasticity means that the collagen and elastin structure of the skin in the area is weaker, which increases the risk of developing or worsening under-eye bags. If we were to weaken the muscle under the eye with Botox in a patient who already has weakened structure in their skin, there would be nothing preventing the fat under these layers from bulging out.  This could lead to under eye bags appearing or worsening.

What Botox Does Help

If a patient with wrinkles under the eyes has a positive snap test, they would likely benefit from Botox injections in the under eye area to relax wrinkles. It is important for patients to realize that the benefits to Botox in the under eye area are limited to treating these types of wrinkles.

 

Woman with under eye bags. Under eye bags can't be treated with Botox.

What Botox Can't Treat in the Under Eyes

Botox is very effective for treating dynamic wrinkles for patients with good skin elasticity in the area. But there are several under-eye concerns that Botox cannot address. Here’s what Botox won’t help with and the alternative treatments we recommend:

Tear Troughs

Tear troughs are the hollow areas under the eyes that can create a shadowed appearance, making you look tired or unhealthy. Botox is not suitable for treating this issue. Fillers and PRP (platelet rich plasma) or PRFM (platelet rich fibrin matrix) injections are potentially great options. These treatments can help restore volume to improve the appearance of hollowness, leading to a refreshed, rested, and rejuvenated appearance.

Discoloration

Dark circles or discoloration under the eyes are often caused by thinning skin, visible blood vessels, or hyperpigmentation. Botox cannot address these concerns, but some patients have experienced significant improvement from PRFM/PRP injections, which are said to improve skin quality and circulation in the area. Other options to help with this include brightening creams, laser treatments, microneedling, and chemical peels that can target pigmentation and improve skin tone for a brighter under-eye appearance.

Under Eye Bags

Under-eye bags are caused by fat herniation or fluid retention and cannot be treated with Botox. The best treatment for persistent or severe under-eye bags is surgery such as a lower blepharoplasty. For mild cases we can attempt RF microneedling to try and melt some of the excess fat and produce some skin tightening.

Lax Skin

Loose, crepey skin under the eyes is caused by a loss of collagen and elastin.  This is normal with age but can be accelerated with stress, age, smoking, and other stressors on the body. Botox does not address skin laxity, but there are several effective treatments. These include:

  • Laser Resurfacing: Stimulates collagen production to tighten and rejuvenate the skin.
  • Microneedling with PRP or Exosomes: Promotes natural skin regeneration for improved elasticity.
  • Prescription Retinoids: Encourage cell turnover and collagen production for smoother, firmer skin over time.
  • Radiofrequency (RF) Procedures: Treatments like TempSure use RF energy to tighten and lift the skin by stimulating collagen and elastin production.

By understanding what Botox can and cannot do for the under-eye area, we can guide patients to the most appropriate treatments for their specific concerns. At The Dermatology and Laser Group we offer a range of advanced options to help you achieve a refreshed and youthful appearance, tailored to your unique needs.

 

By | Categories: Botox, Face and Neck

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