Botox vs Dermalfillers

Crow’s Feet: Botox® versus Juvederm®

Which is better?

When I see patients that are concerned about their crow’s feet wrinkles one of the questions I get asked fairly often is: Which is better Botox® or dermal filler such as Juvederm®?

To answer this, we do need to know how these wrinkles are formed and what is happening below the skin. So a very brief anatomy lesson is in order.

Generally speaking, all wrinkles including Crow’s feet wrinkles, are caused by excessive skin folding, however there are several causes and we need to identify the cause before deciding on our treatment approach.

What Causes Crow’s Feet?

Two things happen when we smile: firstly our eye muscle contracts forcing the skin to fold which in turn produces visible lines that with time and the repetitive movement produces permanent wrinkles that are visible even at rest. The second is the change in the underlying fat pockets around the eye as we age. Fat is very important in our face to help provide not only shape to the overlying areas but very importantly it also provides support which in turn prevents the skin from folding. Furthermore, as the fat thins and/or drops the overlying and underlying muscles become hyperactive (or they contract even stronger) which results in further skin folding and deepening of the crow’s feet wrinkles.

Choices, Choices, Choices: Which Treatment?

Following from the above if I see a patient that is young with good underlying fatty support of the skin and muscles then the treatment choice is Botox®. If at rest visible lines are seen in the skin one can add a fine filler indicated for superficial or skin treatments to further soften their appearance.

If I see a patient that has fat pad loss with excessive skin folding and hyperactive muscle action around the eye, then the best treatment option is combining Botox® with Juvederm. However, the Juvederm would be placed at the level of the fat pad (typically just above bone and not just in the skin) to not only provide support of the overlying skin but to also provide support to the hyperactive muscle. When performed correctly this creates a number of important ‘anti-ageing’ effects around the eye due to the relaxation of muscle contraction at rest and with active smiling:

  1. A change in the shape of the eye: the outer corner turns up (as opposed to a slight downward slope) which is seen in youthful faces
  2. A filling of the shadows and depressions around the eye creating a less tired or ‘haggard’ look and a reduction of the ‘shadow effect’ which in turn makes the eye area look refreshed and brighter
  3. With smiling the eyelids do not contract as much allowing more scleral (white of the eye) show which we see in younger people

So, in a nutshell there is no fixed rule in which treatment is better but rather we should use the best treatment modalities we have depending on the underlying cause of the crow’s feet wrinkles to not only achieve the best results but a more youthful and natural peri-orbital or eye area.

I hope you have found this post informative and useful especially when deciding on treating this delicate but vital area. Should you have any questions or comments feel free to put them in our comment section below or contact us directly.

Kind regards

Dr Alek Nikolic

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