| Lateral canthal lines (“crow’s feet”) with smiling; lines are mostly or entirely gone in repose |
| Inferior pretarsal orbicularis bunching (“jelly roll”) and narrowing of the palpebral fissure (squinting) with smiling |
| Lateral canthal lines mostly when patient smiles. Some patients will have asymmetry in the prominence or location of the lines. Often the lines are more prominent on the side that gets sun exposure when driving (the left in the United States) |
| Evaluation for inferior pretarsal bunching with smiling or squinting with smiling |
Introduction
Botulinum toxin injections are the most frequently performed cosmetic procedure in the United States. The injections have a high satisfaction rate and offer the advantages of minimal risk and minimal downtime. Botulinum toxin injections are often sought out by patients who may not yet be candidates for cosmetic surgery.
Botulinum toxin injections are most effective when used to treat dynamic wrinkles (wrinkles present with animation) rather than static wrinkles (wrinkles present at rest). Static wrinkles may respond at least partially to botulinum toxin injections, but often require treatment with dermal fillers or laser skin resurfacing. Botulinum toxin injections work by blocking the release of acetylcholine at the neuromuscular junction. The effect of botulinum treatment may take 1–2 weeks to fully manifest, and the effect lasts 3–4 months.
Currently there are three FDA-approved brands of botulinum toxin type A: onabotulinumtoxinA (Botox®), abobotulinumtoxinA (Dysport®), and incobotulinumtoxinA (Xeomin®). Our dosing recommendations apply to Botox® and not necessarily other toxins.
The crow’s feet are a very commonly treated area, with a high rate of patient satisfaction. Although essentially similar, not all toxins have the same FDA-approved indications for treatment. Please consult the packaage insert for each respective toxin to determine on-labelled indications.
Surgical Technique
