Crows Feet Are For The Birds

As the eyes age, it is inevitable that lines will develop around the eyelids. These periorbital lines, or crow's feet as they are often unflatteringly referred, develop because of the excessive muscle activity under the skin. When the muscle action goes on long enough, the skin becomes permanently creased or wrinkled. As wrinkle lines form perpendicular to the action of the encircling muscle around the eye, wrinkles develop and radiate outward in a 'sunray' effect.

Elimination or softening of these lines is a frequently requested procedure. While this request is simple, adequately treating crow's feet often requires combination therapy. Botox remains as the primary treatment method for the crow's feet area. 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 necessay, 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. The combined use of Botox and laser skin resurfacing will be necessary for established or deep crow's feet lines. The combination of muscle weakening (Botox) and skin resurfacing (laser) can make some real dramatic changes over time. The thinness of the skin around the eyes makes it particularly susceptible to the effects of 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.

Laser depths around 35 to 50 microns (deep laser resurfacing is around 200 - 300 microns) are easily tolerated in the office under topical anesthetic cream, are quick to perform, and require minimal post-treatment care. The crow's feet area is pre-treated with Botox during the same visit and then laser resurfaced. Lighter laser resurfacing is done to allow for a quick recovery. 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 his private practice at Clarian North and West Medical cenetrs in suburban Indianapolis. He writes a daily blogs on topics and trends in plastic surgery at

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