Under-Eye Botox: Risks, Benefits, and Alternatives

1. Few requests make injectors pause like “Can you put Botox under my eyes?” The area looks small, but it carries outsized complexity. Skin is thinnest here, fat pads shift with age, muscles pull in unexpected directions, and even a tiny miscalculation can alter your expression. I have treated hundreds of eyes over the years, and while Botox Cosmetic is a powerhouse for crow’s feet and an elegant eyebrow lift, the under-eye itself is a more nuanced call. Done for the right person with the right technique, it can soften a crinkled smile and subtly refresh the lower lid. Done for the wrong anatomy or dose, it can cause smile weakness, puffiness, or that “tired when you’re not” look. Let’s unpack what under-eye Botox can and cannot do, who is a good candidate, what a safe botox procedure involves, and where better alternatives may live. What under-eye Botox actually targets Botox injections work by relaxing muscles. In the eye area, the orbicularis oculi is the ring-shaped muscle that helps you blink and squint, and it creates dynamic wrinkles that fan outward as crow’s feet and crease under the lower lid when you smile. Botox for wrinkles around the eyes reduces that scrunching. When someone says “under-eye Botox,” they usually mean micro-doses placed just below the lash line to quiet that lower-lid scrunch. The goal is not to freeze the eye, but to take the harsh edge off repetitive pinching that etches fine lines. If your main complaint is fine horizontal creasing that shows only when you grin or laugh, micro-dosed under-eye Botox can help. If your concern is hollowing, dark circles from thin skin, or bulges from herniated fat pads, Botox is not the tool. Those issues fall into volume, pigment, vascular, or structural categories and call for different strategies. The difference between treating crow’s feet and treating under the eye Botox for crow’s feet is predictable because the outer orbicularis is a thick, superficial muscle. Doses range from 6 to 12 units per side for most women and 10 to 16 units per side for most men, adjusted for muscle strength and desired mobility. The injection points sit just lateral to the eye socket. Results last about three to four months, sometimes up to five in low-movement faces. Under-eye placement is trickier. The lower orbicularis is thinner, and it coordinates with cheek elevators such Click here as the zygomatic major and minor. Over-relax it, and you alter smile dynamics, creating a slightly flattened or “heavy” lower lid. Under-dose it, and you barely see a change. Typical micro dosing is 1 to 2 units per injection point in one to three points per side, often totaling 2 to 6 units per lower lid. I prefer the low end for a first-timer, with a botox follow up at two weeks to consider a conservative touch up if needed. Who is a good candidate for under-eye Botox The best candidates share a few traits. They have thin, crinkly skin that wrinkles when they smile, yet the lines are shallow at rest. They do not have significant under-eye puffiness, pronounced eye bags, or lower-lid laxity. Their cheek support is good, so relaxing the lower-lid muscle will not unmask a bulge. They can accept a subtle result and value a natural look over dramatic change. I also look at blink strength and dryness. If you have dry eyes or a weak blink, relaxing any portion of the orbicularis can worsen symptoms. Contact lens wearers or those with a history of LASIK may be more sensitive, so I test gently and err on the side of less. Age matters less than anatomy. I have treated someone at 28 with intense smile crinkles who looked fresher after 2 units per side, and I have declined someone at 48 whose under-eye hollowing and fat herniation would only look worse with muscle relaxation. That person did beautifully with a tiny, carefully placed hyaluronic acid filler instead, plus skin quality treatments. What to expect during a botox consultation and procedure A good botox consultation should feel like a joint evaluation. Your injector will watch your face at rest and in motion, ask what specifically bothers you, and test the lower-lid snap-back to gauge laxity. Expect a discussion of botox benefits and botox side effects, as well as alternatives. If you hear “We can fix everything with Botox,” that is a red flag around the eyes.

2. On treatment day, makeup is removed and the skin is cleaned. For under-eye work, I mark conservative injection sites just beneath the lash line, avoiding visible vessels. The botox dosage is very low. Most people describe the botox pain level as a quick pinprick with minimal botox downtime. You may see tiny blebs that settle within minutes and occasional pinpoint botox bruising, especially if you bruise easily. Botox results time is not instant. You start seeing changes at day 3 to 5, with full botox results at day 10 to 14. I schedule a botox follow up at two weeks to review botox before and after photos, discuss botox wear off signs to watch for around month three, and plan botox maintenance if appropriate. For a first-time under-eye treatment, I will not stack the full expected dose on day one. Under this eye, you earn the dose. Benefits that are realistic When properly selected and dosed, under-eye Botox can soften smile-induced creasing and create a smoother transition from lower lid to upper cheek when you laugh. The change is often “I look less crumpled when I’m happy,” which most people like. If you enjoy botox for face treatments and already do botox for crow’s feet, adding a tiny under-eye component can round out the perimeter of the eye for a cohesive refresh. The psychological benefit matters too. Many of my patients are expressive. They do not want to stop smiling, they just do not want their eyes to bunch into an accordion every time they do. A subtle improvement can let a genuine smile come through without broadcasting fatigue. Risks and side effects specific to the under-eye Every botox treatment has potential reactions like redness and bruising. The under-eye region adds its own list. The most common complaints are transient swelling or a puffy look, usually from relaxing a muscle that was compressing soft tissue. In patients with preexisting lower-lid laxity or fat pad prominence, that puffiness can be more noticeable and last until the botox results duration ends. Some people report a slightly weaker smile or a sense that the cheeks do not lift as much. This usually correlates with dose or injection height. Dryness can increase if blink mechanics change. Those with baseline dry eye, blepharitis, or significant screen time should consider this. On the rare side, you can see lower-lid malposition or edge rounding if dosing is high or placement imprecise. I do not advise treating the under-eye if you have a history of eyelid surgery that altered support, unless the surgeon and injector coordinate carefully. Safety in this area hinges on experience. A botox dermatologist or a certified botox nurse injector who treats under-eye cases weekly will know how to evaluate risk and dose thoughtfully. If a provider recommends 8 to 10 units under each eye casually, ask how often they treat this zone and how they manage complications. Small numbers make a big difference here. How long the results last and how often to repeat Typical botox results duration for the under-eye is around three months, sometimes shorter. Because we use small doses, the effect can wear off a bit sooner than it does for crow’s feet. Most people consider a botox frequency of three to four sessions per year if they want steady results. A botox touch up schedule often includes a check at two weeks, then a plan to treat again at the 12 to 16 week mark if the look is fading and the prior round was well tolerated. I remind patients that faces change with seasons, dehydration, and allergies. If spring pollen puffs your eyes, I might delay maintenance by a few weeks to avoid stacking swelling variables. Cost context and how to think about price Botox price varies by region and provider experience. You will see botox cost quoted per unit, commonly 10 to 20 dollars per unit in many U.S. markets, or a flat fee per area. Under-eye treatments use fewer units, but you are paying for precision. Expect 100 to 250 dollars as a typical range if you are adding micro doses under the eyes to an existing botox procedure, though some metropolitan practices charge more. If you search “botox near me specials,” evaluate the value beyond the sticker price. An inexpensive session that leaves you puffy or asymmetric can cost more in correction and time than a carefully planned treatment. Check botox clinic reviews, ask how many under-eye cases the injector handles weekly, and request to see botox before and after images specific to the lower lid, not just crow’s feet.

3. Botox vs Dysport, Xeomin, and others around the eyes Most neuromodulators on the market work similarly as a muscle relaxer, but they diffuse differently. Dysport can spread a bit more than Botox Cosmetic, which sometimes helps soften a broader area with fewer injections, but that diffusion can be a liability in the under-eye. Xeomin lacks accessory proteins, which some patients prefer. In practice, I tend to use Botox Cosmetic or Xeomin under the eye for tighter control. Dysport remains excellent for crow’s feet in the hands of an injector who understands its spread. If a patient is new, I stick with the product I know best for that anatomy. If you have a history of good results with botox vs dysport elsewhere, we can keep the same product but adjust the approach for this zone. When under-eye filler, skin treatments, or energy devices work better Many under-eye complaints have little to do with muscle contraction. If your lower lids look hollow, Botox will not fill a volume deficit. If the issue is crepey skin at rest, Botox cannot rebuild collagen. Here are more suitable directions I often recommend after a careful exam: Tear trough filler with a soft hyaluronic acid, placed deep for shadowing and cautiously for the medial trough. This helps with hollowing and a persistent dark trough line. Avoid if there is visible edema or a history of prolonged swelling. Skin quality strategies such as microneedling, fractional non-ablative lasers, or very light chemical peels to improve crepey texture. Multiple sessions and ongoing skincare, including retinoids and well-formulated eye creams, build gradual improvement. Energy-based tightening like radiofrequency microneedling or gentle ultrasound to stimulate collagen in appropriate candidates. This can firm mild laxity over months. Vascular or pigment management through lasers or topical brighteners if redness or brown pigment is the primary driver of “dark circles.” Cheek support with filler if midface deflation contributes to an under-eye shadow. Restoring the cheek’s lift can indirectly soften the lid-cheek junction and reduce the perceived need for under-eye work. These options can be combined with botox for crow’s feet while skipping under-eye injections entirely. The effect is a more comprehensive, safer rejuvenation for many faces. A realistic example from practice A 35-year-old woman, fair-skinned, came in asking for Botox for under eyes. Her photos showed deep crinkling only when she smiled, with smooth skin at rest, no bags, and good cheek support. We placed 2 units per side under the lash line and 8 units per side for crow’s feet. At her two-week review, she looked refreshed, and we added 1 unit per side for a touch up. She repeated at four months with the same dosing and consistent results. Contrast that with a 44-year-old man who wanted “no lines under my eyes.” He had mild herniated fat and a slight lid laxity. Under-eye Botox would have flattered him for two weeks but increased puffiness through the rest of the cycle. We declined under-eye injections, treated crow’s feet lightly, and focused on skin quality with fractional laser and an eye-safe retinoid. Six months later, his before and after images showed smoother texture and less shadow without disturbing his natural smile. The role of dose, dilution, and technique Under-eye success is often a story of restraint. Baby Botox and micro Botox concepts apply here, but they require precise placement rather than simply diluting more. I keep injections very superficial to avoid diffusion into deeper elevators and stay at least a few millimeters below the lash line to reduce the risk of eyelid dysfunction. I also plan the session with the entire upper face in mind. If we are treating botox for forehead lines, botox for frown lines between the eyebrows, a subtle botox eyebrow lift, and crow’s feet, the under-eye portion is the last piece of a coordinated plan to preserve expression while smoothing hotspots. Units per area are less meaningful than understanding your anatomy. A muscular, expressive face might need several more units at the crow’s feet while still receiving the same micro dose under the eye as a less expressive face. It is common for men to require more toxin at the lateral canthus due to muscle bulk, yet the under-eye dose rarely scales upward at the same rate. Aftercare, downtime, and what not to do

4. Immediate aftercare is simple. Avoid rubbing the area, heavy workouts, saunas, or face-down massage for the rest of the day. Sleep with your head slightly elevated if you are prone to swelling. If a pinpoint bruise appears, a small amount of concealer is fine the next day. Persistent swelling is uncommon with such small doses, but if you wake with notable under-eye puffiness, it is usually mild and improves over a few days. Alcohol and high-sodium meals can exaggerate swelling, so saving celebratory dinners for 24 hours later can help. If you develop eye dryness, use preservative-free artificial tears and alert your injector. Keep photos handy for your review appointment so we can compare botox before and after frames and decide if a touch up makes sense. Debunking a few myths Botox is not a filler. It will not plump hollows or lift tissue. It will not erase pigment. It will not “thin the skin.” It does soften muscle-driven lines and, in some cases, may reduce the appearance of texture that appears only with motion. Another misconception: more is better. Around the eyes, more can mean less natural, more puffy, and more risk. A subtle enhancement that softens your smile lines while keeping your expression intact is usually the right target. Finally, the idea that once you start, you cannot stop is not true. Botox wears off. If you dislike the under-eye effect, we simply do not repeat it. Many of my patients continue with botox for forehead lines and crow’s feet but skip under-eye doses after a trial. Others keep the under-eye micro dose as part of their botox maintenance because it quietly makes them look well-rested. Combining Botox with other treatments for a balanced plan Face aging is multifactorial. Dynamic lines respond to neuromodulators. Volume loss benefits from fillers, fat grafting in select cases, or even a surgical blepharoplasty if fat pads protrude. Skin quality improves with consistent skincare, sun protection, and targeted treatments. When we stack small, appropriate interventions, the sum looks more natural than any single aggressive move. I often pair botox cosmetic at the crow’s feet with a mild resurfacing plan under the eyes. A low-concentration TCA peel, fractionated non-ablative laser, or microneedling series can upgrade the canvas while Botox smooths motion. If hollows are significant, a conservative filler session after we understand your botox results can finish the picture. Timing matters. I like to separate energy treatments and injectables by a week or more, depending on the device and depth, to minimize compounded inflammation. Safety checklist before you proceed Choose a botox certified provider with substantial under-eye experience, ideally a botox dermatologist or a seasoned botox nurse injector supervised by a physician. Bring specific concerns and priorities to your botox consultation. What bothers you most, movement lines or lines at rest? Do puffy mornings happen? Do your eyes feel dry frequently? Start with minimal dosing. Ask for a conservative plan with a two-week reassessment. Photograph in consistent lighting, neutral face and smiling. Keep these for comparison so decisions are grounded in evidence, not memory. Accept that under-eye Botox is not for everyone. If your anatomy resists this approach, a skilled injector will steer you toward safer, more effective alternatives. Special cases: men, first-timers, and migraine patients Men tend to have denser orbicularis muscles, which means more units at crow’s feet but not necessarily under the eye. Because subtlety is the aim, I still micro dose the lower lid if we treat it at all. First-time patients should expect a lighter initial result and a learning period for both injector and patient. We are tuning your face, not flipping a switch.

5. For those receiving botox for migraines, dosing patterns focus on the forehead, temples, occiput, and neck per established protocols. If you are already on a migraine schedule, discuss with your injector whether piggybacking cosmetic crow’s feet or under-eye micro doses makes sense. We want to avoid overlapping too many treatment zones without coordination. Where Botox fits among broader facial goals Botox for face treatments can address forehead lines, frown lines, crow’s feet, bunny lines on the nose, a gummy smile, lip flip for subtle enhancement at the vermilion border, masseter contouring for jawline slimming, chin dimpling, and neck bands. Most of these areas are more straightforward than the lower lid. The under-eye should be approached with the same respect you would give to a delicate watch mechanism: small moves, measured benefits, clear stop points. If you are trying Botox for the first time, I usually recommend starting with classic areas like the glabella and crow’s feet to understand how you animate with toxin on board. Once you like that baseline, we can decide whether a micro move under the eye will add value or distract from your natural spark. Final thoughts from the treatment chair Under-eye Botox is neither a miracle nor a mistake by default. It is a technique that can help a narrow slice of patients when used precisely and sparingly. The real art lies in choosing when not to use it. If you walk into a consultation and your injector spends more time studying your smile than selling you a syringe, you are in good hands.

6. Ask good questions. Review botox reviews and testimonials critically. Decide whether your goal is smoother motion, better texture, more support, or all of the above, then use the right tool for the job. Under-eye Botox can be part of a smart, natural-looking plan, but it should never be the plan itself.