Botox® Under Eyes — Injection Sites

Author

Dr. Stephen Cosentino

Botox® is FDA approved to treat a variety of cosmetic and musculoskeletal complaints of the head and face, from frown lines to chronic migraine. Every year seems to bring new approved uses and new Botox injection sites.

One area of the face where Botox hasn’t received the FDA’s official sign-off yet is directly under the eyes. Should that worry cosmetic patients considering Botox under the eyes?

The short answer is no. Botox’s anti-aging power appears to work well under the eyes — with some caveats. Here’s what you need to know.

Botox Under Eyes — Injection Sites

When we talk about Botox under and around the eyes, we’re really talking about several different places to deliver Botox injections.

Crow’s Feet Area

The corners of the eyes are among the most popular places to inject Botox on the face. Botox is FDA approved to treat wrinkles and fine lines in this area.

Bunny Lines Area

Botox can be injected into the sides of the upper nose bridge to treat bunny lines and reduce the “scrunching” effect that increases with age. Injections on the edges of this area occur under the eyes.

Directly Under the Eyes

Botox can also be injected into the facial muscles under the eyes to treat conditions like eye wrinkling and excessive under-eye bags. These treatments can achieve the desired effects with small amounts of the medication — typically no more than 1 to 2 units of Botox per injection site.

Botox Under Eyes — Effectiveness & Other Considerations

Botox is FDA approved for a wide (and growing) range of cosmetic treatment indications. We know that it’s safe and effective when used as indicated.

But not all Botox injections under the eyes are yet approved by the FDA. Does that make them less effective than Botox treatments elsewhere on the head and face?

Has Botox in the Eye Area Been Medically Reviewed?

Medical research into Botox injections directly under the eyes is limited, but what we do know is encouraging.

A 2003 study found that small-dose Botox injections into the lower eyelid helped lessen facial wrinkles in that area and widen the eye opening. Patients in the study received up to 8 units of Botox.

It’s likely that more research is needed into Botox use in the lower eyelid and eye bags. For now, patients can feel confident working with a trained provider for this off-label use.

Who Is a Good Candidate for Botox Under the Eyes?

Good candidates for Botox under the eyes are:

Over 18 years old
Have good facial muscle function in this area
Don’t have excessive wrinkling or muscle deterioration under the eyes
Don’t have any other known contraindications for Botox

The ideal patient is already receiving Botox for other eye-adjacent indications, such as crow’s feet.

What Are the Side Effects of Botox Work Under the Eyes?

Botox side effects tend to be mild and temporary. They can include:

Pain around the injection site
Itching or redness around the injection site
Mild swelling
Numbness
Minor bleeding

Botox under the eyes is an “off-label” use that may occur in conjunction with other minimally invasive cosmetic procedures, such as dermal filler injections.

This doesn’t mean it’s less safe than other approved Botox uses, but it’s still best to work with a provider who has completed advanced Botox and dermal filler training.