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.

The main treatment for crow's feet is Botox injections. 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. If you inject too long below the cheek bone, there is a real chance that one's smile will be temporarily affected. 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.

For the older patient who at rest already has established crow's feet wrinkles, combination therapy will be needed. 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. In those patients who have an isolated facial concern about the crow's feet, deep or more extensive facial skin resurfacing is not done. Rather I use a light to moderate depth laser resurfacing so that healing occurs quite quickly, usually within three to five days. Light laser resurfacing can be easily and quickly done in the office with an equally uncumbersome and expeditious recovery. 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.