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Posted 15th May 2024

Periorbital Botox: How to Treat Crow’s Feet

Crow's feet before botox

Here’s everything you, as an injector, need to know about periorbital botox, specifically how to treat crow's feet.
Clinical trainer and aesthetics specialist Kate Smith, RGN, offers her clinical insights into these fine lines around the eyes. Kate is an aesthetic nurse and completed her Level 7 Diploma in Botox & Dermal Fillers with Harley Academy. 

What are crow's feet?

Kate tells us, “Crow’s feet or 'laughter lines' around the eyes are anatomically known as lateral canthal lines. These are a common concern among individuals seeking medical aesthetic interventions.

“These fine lines and wrinkles, which radiate from the outer corners of the eyes, are often associated with ageing. They can impact a patient's appearance and self-confidence significantly.”

What causes them?

Kate explains, “The breakdown of collagen and elastin fibres in the skin around the eyes causes crow’s feet. These develop over time through repetitive facial expressions, such as squinting, smiling, laughing, crying, and even sun exposure.

“As a result, dynamic wrinkles form, manifesting as crow’s feet lines when the orbicularis oculi muscle contracts. Over time, these fine lines may start appearing on your face when you’re not smiling, or at rest. These are often referred to as ‘static’ lines.

She continues that “other contributing factors may play a role in how the skin around the eye area ages. For example, age-related intrinsic factors such as:

  • Loss of skin elasticity
  • Hyperactive muscles
  • Loss of collagen and fat
  • Bone loss.”  

Extrinsic factors linked to laughter lines

Kate further notes that “external factors can lead to skin damage too. Smoking, exposure to the sun, whether you use sunscreen and diet all contribute to the formation of facial lines.”  

Harley Academy Trainee Marking up Crow's Feet for Botox

Understanding facial anatomy is the first step in treating crow's feet

“To effectively address crow’s feet lines, it’s essential to understand the underlying anatomy,” Kate shares.

Understanding facial anatomy is, in fact, crucial when treating every area. For that, you need comprehensive medical aesthetics training. 

Like Kate, you can learn about facial anatomy and how various factors affect each layer of the skin on our Level 7 Diploma in Botox & Dermal Fillers course.

The role of the orbicularis oculi muscle

“The orbicularis oculi muscle plays a crucial role in the formation of crow’s feet lines. This circular sphincter muscle surrounds the eye and acts as a depressor when activated. 

“The main function of the orbicularis oculi muscle is to close the eyelids, which occurs when the muscle contracts. 

“Contraction of the muscle also assists in draining tears from the eyes via the lacrimal gland pump system. This is important when considering patients with oedema around the eye area.” With these patients, consider not treating or reducing the toxin dose so as not to worsen any present oedema. 

How to treat crow’s feet using botox

Kate reports that “Botulinum toxin injections are probably the most popular choice for minimising the appearance of dynamic wrinkles.

“By temporarily relaxing the orbicularis oculi muscle, and blocking muscle contractions, these neurotoxin injections can smooth out crow’s feet lines. This also theoretically reduces further wrinkle formation in the future.” 

As always, do discuss realistic expectations with your patients. For example, it’s unlikely that more static lines will resolve with this treatment. 

To treat crow’s feet with botox, inject superficially into the dermis approximately 1 cm away from the orbital rim. The licensed dose is 4 units per point, at 3 points, with a total of 12 units per side. 

Take care to ensure injections are not placed:

  • Too close to the orbital rim, so that the ocular muscles are not affected and the eye can perform it’s aperture function
  • Too deep at the lower aspect, so that the smile muscles are not affected
  • Too deep at the upper aspect, so that the lacrimal gland is not affected.

It’s useful to consider other options to manage crow’s feet alongside botox plans.

Injecting botox into the crow's feet lines around the eye at Harley Academy

How to treat crow’s feet without using toxin

Kate states, “Medical aesthetic practitioners have multiple treatment options available. All of which effectively target crow's feet lines and rejuvenate the delicate eye area.” She lists the following…

Lifestyle choices

Minimising sun exposure and wearing SPF 30+ or higher can protect your skin from harmful UV rays from the sun.” Ideally a broad spectrum SPF 50 should be worn daily all year round and reapplied regularly throughout the day.

“Wearing sunglasses or a wide-brim hat will shield your eyes from the sun's rays. This can help prevent squinting, contributing to muscle contraction, fine line and wrinkle formation.”  

Skincare to support treatments

“Targeted skincare formulations containing retinoids, peptides, and antioxidants can  complement treatments and prolong the results of crow’s feet treatments. 

“Using sunscreen and an eye cream can help strengthen the delicate skin around the eye area and prevent fine lines from forming.” 

Skin treatments for crow’s feet

“Incorporating minimally invasive skin treatments, such as chemical peels or microneedling, can further enhance the efficacy of crow's feet treatments. 

"These minimally invasive procedures which allow penetration deep into the dermis stimulate collagen production and improve skin texture. This results in smoother, firmer skin around the eyes.”

There are also newer treatments available, like polynucleotide injectables, that can help to improve skin quality in the region.

Offer your patients an holistic treatment plan

If you’re looking for aesthetic medicine training that empowers a skin-first approach, our Combined Level 7 Diploma, blends cosmetic dermatology with injectables training. 

You’ll learn how to safely execute treatments such as Profhilo and microneedling as well as botox and filler training. So when it comes to creating bespoke treatment plans , you’ll be able to offer your patients a holistic view.

Our Combined Level 7 course consists of eLearning, live injecting demonstrations and one-to-one mentoring for a 360º learning experience. 

If you’d like to hear more about how we can help you achieve your career goals, book a call with one of our Course Advisors

All information correct at the time of publication

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