Crow’s feet botulinum toxin
Crow’s feet treatment delivers 6–12 units per side into the outer fibres of orbicularis oculi, the ring muscle around the eye, to soften the fan-shaped lines that open when you smile.
- Procedure time
- 10 minutes
- Anaesthesia
- Usually not needed; topical anaesthetic cream on request
- Recovery
- Back to normal the same day
- Sessions
- One session · review at week 2
- How long it lasts
- 3–5 months
The target muscle: orbicularis oculi
Orbicularis oculi is a thin muscle that rings the eye. It contracts when you smile, when you squint and when you look into bright light; each contraction opens a fan of lines from the outer corner of the eye towards the temple.
It is the thinnest expression muscle in the face and it sits very close to the skin. Injections here are therefore superficial rather than deep, and the doses are low.
Marking is done while you smile. The direction of the lines varies from person to person — in some the fan spreads upward, in others downward — and the points are distributed accordingly.
How the dose is calculated
The typical range for crow’s feet is 6–12 units per side, which usually corresponds to 12–24 units for both sides together.
The dose need not be identical on the two eyes. Human faces are not symmetrical, and where one side contracts more strongly, one or two extra units on that side restore the balance.
- How many lines open on smiling and how wide they spread
- Muscle strength — a patient who can squeeze the eye tightly shut moves towards the upper limit
- Whether there are lower lines extending towards the cheekbone
- Asymmetry between sides — doses are adjusted individually
The day of treatment
Injections are given at 2–4 points per side, kept at least a centimetre outside the bony rim of the eye socket. Total time is around 10 minutes.
The vessels here are fine and superficial; the most common expected effect is a small bruise, which fades within a few days. If you take blood thinners that likelihood increases.
Do not lie down or massage the area for the first four hours. Eye make-up is not applied the same day — worth knowing if you have plans that evening.
The timeline of the effect
The effect starts at days 3–7 and settles fully at days 10–14. Around the eye it lasts slightly less than elsewhere on the face: 3–5 months on average.
The reason it is shorter is that the muscle is thin and works continuously all day. Blinking, smiling and reacting to light never let it rest.
At the week-two review, a low-unit touch is added if a difference between the sides remains.
What decides the result
The result is decided by the distance from the cheek. An injection placed too far down and in can affect the muscles that lift the upper lip and cause asymmetry in the smile. Keeping the safe distance means that is not expected.
Crow’s feet treatment works on lines that open with movement. Under-eye bags, skin laxity and lower lid droop are not muscular; botulinum toxin does not correct them.
If a high dose is placed into the fine lines immediately below the eye, the lower lid muscle loses support and the under-eye area can look puffier. Fewer units produce a better result here than more.
Who this is not for, and what not to expect
Botulinum toxin is a prescription medicine with its own contraindications. Previous surgery around the eye, dry eye symptoms and lower lid laxity are all assessed at examination.
What should not be expected here is clear: botulinum toxin does not correct under-eye bags, skin laxity or lid droop. It only softens the line that opens with movement.
- Pregnancy and breastfeeding — not treated
- Neuromuscular disease (myasthenia gravis, Lambert-Eaton syndrome, motor neurone disease) — not treated
- Aminoglycoside antibiotics — they can amplify the effect of the toxin; not treated until the course is finished
- Active infection or inflammatory skin disease around the eye — not treated until it clears
- Known hypersensitivity to botulinum toxin — not treated
- Bleeding disorder or anticoagulant use — bruising is markedly more likely in this area
- Static lines around the eye that are present when the face is still will not be released by botulinum toxin alone
This page is general information and does not replace a clinical examination. The method, dose and timescale that apply to you are decided by a doctor after examining you.
Frequently asked questions
How many units do crow’s feet take?
Will it correct my under-eye bags?
Will my smile change?
Why does it last less time here?
Pre-assessment
Describe your situation and we will answer with a measurement
Send a photograph or an X-ray. A doctor in the relevant speciality will reply with a graft range, a number of teeth or a dose range in units. If you are not suitable, we say so plainly.