Under-Eye Wrinkle Botox: Which wrinkles does it work on? What to check before getting it

Under-eye wrinkle Botox is effective only for 'dynamic wrinkles' caused by the contraction of the orbicularis oculi muscle when laughing or making facial expressions. The principle is that Botulinum Toxin Type A temporarily relaxes muscles by blocking acetylcholine release at nerve endings. Conversely, the effect is limited on static wrinkles that remain visible even when resting, under-eye hollows, fat protrusion, or pigmented dark circles.

Therefore, the first thing to consider regarding under-eye wrinkle Botox is "what type of wrinkles do I have." If you misidentify the cause, it is hard to be satisfied even after receiving the treatment. Since the under-eye area is the thinnest skin on the face, an excessive dose or inaccurate injection can lead to regrettable results, such as a reduction of the under-eye roll (aegyo-sal). We will address these issues one by one below.

🎯 What is under-eye wrinkle Botox?

Specifically, under-eye wrinkle Botox is a procedure in which a small amount of Botulinum Toxin Type A is injected into the lower orbicularis oculi muscle. The orbicularis oculi is a donut-shaped muscle surrounding the eye, and the repeated contraction of this muscle creates fine wrinkles under the eyes.

Looking closer at the mechanism of action, it works like this. Botulinum toxin cleaves a protein called SNAP-25 in synaptic vesicles, thereby blocking the release of acetylcholine, a neurotransmitter. This cuts off the contraction signal to the muscle, allowing the muscle to relax and smoothing out the wrinkles.

The important thing to note is that this effect is reversible. The drug does not permanently eliminate muscles but temporarily rests them, meaning it gradually returns to normal after an average of 3 to 6 months.

📌 Key Summary: Under-eye wrinkle Botox is a procedure that temporarily suppresses the contraction of the orbicularis oculi muscle to smooth out expression wrinkles, and the effect is not permanent.

💡 Which wrinkles does it work on, and which does it not?

This is the key point that determines satisfaction with the procedure. Distinguishing between dynamic wrinkles and static wrinkles is the starting point.

There is a simple self-check method. Compare your face in the mirror when you have an expressionless face versus when you smile brightly. If they are highly visible only when you smile and fade when you have an expressionless face, they are likely dynamic wrinkles; if deep furrows remain even when resting, they are closer to static wrinkles.

For under-eye hollows or deep static wrinkles, an approach that fills volume using hyaluronic acid filler is more appropriate. While Botox is a procedure that 'rests muscles,' filler is a procedure that 'fills hollow areas.' Since their principles are completely different, it is best not to confuse them.

If it is a problem of the skin itself, such as pigmented dark circles, the limitations of Botox are clear. In this case, lasers targeting pigment and skin texture, or skin boosters that restore moisture and elasticity from deep within the skin, are considered together.

📌 Key Summary: Botox is more suitable for dynamic wrinkles that appear when laughing, fillers are better for static wrinkles and hollows that remain when expressionless, and lasers or skin boosters are better for pigmentation issues.

⏱️ When does the effect start, and how long does it last?

The effect does not appear immediately. Usually, it begins to manifest gradually 2 to 3 days after the procedure, reaching its peak around 1 to 2 weeks. Therefore, there is no need to feel disappointed looking in the mirror right after the procedure. You need to wait at least 2 weeks to see the actual results.

The duration of the effect is an average of 3 to 6 months. Once muscle strength returns, the wrinkles will reappear, so repeated procedures are necessary if you wish to maintain the results. However, it is safer to keep the interval between treatments to at least 3 to 4 months.

Interestingly, clinical reports suggest that the maintenance period tends to gradually lengthen with consistent treatments. It is easy to understand this as the habit of making wrinkles itself weakening as the muscles repeatedly rest.

📌 Key Summary: Under-eye Botox starts to take effect after 2 to 3 days, peaks at 1 to 2 weeks, and lasts for 3 to 6 months, with a tendency for the duration of action to increase when repeated.

⚠️ Why the under-eye area requires extra caution

The under-eye area is one of the most difficult parts of the face to treat. The skin thickness of the eyelid is around 0.3 to 0.5 mm, which is among the thinnest on the face, and it is directly linked to functions like tear film distribution and eye closure.

Thus, there is only one golden rule: a small dose, in the precise location. Even a slightly higher dose or a slightly off-target injection site can make a huge difference in the results.

Here is a summary of the representative aspects that require careful attention:

• Loss or reduction of the under-eye roll (aegyo-sal): The under-eye roll is a structure where the lower eyelid orbicularis oculi muscle is slightly prominent, and it can decrease with an excessive dose or inaccurate injection, so this must be checked before the procedure.

• Exacerbation of under-eye fat protrusion: If you already have bulging under-eye fat, weakening the orbicularis oculi muscle can make the fat protrusion look even more prominent.

• Ptosis (drooping eyelid): If the drug unintentionally diffuses or is injected into the wrong place, side effects such as drooping eyelids can occur.

• Tear pooling · weakened lower eyelid support: This can occur if repeated or excessive treatments accumulate.

In particular, if under-eye fat protrusion is prominent or the lower eyelid elasticity is significantly reduced, other methods such as under-eye fat repositioning may address the root cause better than Botox. This structural evaluation is something that must be covered during the pre-procedure consultation.

📌 Key Summary: Because the under-eye skin is thin and its functions are sensitive, a small dose and accurate injection are essential. The potential for reduction of the under-eye roll, worsening of fat protrusion, and ptosis must be thoroughly checked before the procedure.

🚫 Please inform us of these conditions before the treatment

Although botulinum toxin has a wide safety margin, there are certain situations where caution is definitely required.

• If you have neuromuscular junction disorders such as myasthenia gravis or Lambert-Eaton syndrome

• If you are pregnant or breastfeeding (not recommended as safety has not been established)

• If you have dry eye syndrome — a decrease in orbicularis oculi muscle function can affect tear film distribution and eye closure, requiring prior confirmation

Also, when receiving under-eye Botox and crow's feet (outer eye wrinkles) Botox at the same time, the dosage must be carefully distributed to prevent the overall function of the orbicularis oculi muscle from becoming excessively weak.

One more thing. Unlike fillers, there is no immediate way to reverse Botox if side effects occur. While fillers can be dissolved with digestive enzymes, you have to wait for the toxin's effect to wear off naturally over time. Therefore, it is crucial to approach it cautiously from the very beginning.

📌 Key Summary: Neuromuscular diseases, pregnancy, and breastfeeding are major contraindications, dry eye syndrome requires prior notice, and extra caution is needed as Botox cannot be immediately reversed like fillers.

🔍 What is the approach when Botox alone is not enough?

It is rare for under-eye concerns to be limited to just a single wrinkle. In most cases, fine wrinkles, dry skin, pigmentation, and reduced elasticity are mixed together. In these situations, Botox alone inevitably has its limits.

Therefore, for the under-eye area, an approach that combines treatments based on the cause is natural.

• If moisture, texture, and elasticity deep within the skin are the issue, skin boosters can help. Skin boosters specialized for the under-eye area include Rejuran i, Juvelook Volume, and Lituo Fine, which are used to soothe the texture and elasticity of the thin and sensitive under-eye skin itself.

• If pigmented dark circles or a decline in skin texture and elasticity are prominent, laser treatments are considered together.

• If static wrinkles and hollows coexist, fillers can be used to supplement volume.

For sensitive areas like the under-eye, Onlif Clinic aims for an approach of finely combining non-surgical treatments customized to the skin condition, rather than pushing through with a single procedure. It is closer to clearing away skin concerns that mask your natural impression, rather than altering your features.

📌 Key Summary: Since the under-eye area often presents a mix of wrinkles, dryness, pigmentation, and loss of elasticity, combining Botox with lasers, fillers, or skin boosters like Rejuran i, Juvelook Volume, or Lituo Fine is highly effective.

📋 How to care for it after the procedure

Although the procedure itself is short, the care you take in the hours following it will affect the results. Think of it as a process to help the drug settle stably into the targeted muscles.

• Maintain an upright posture with your upper body elevated for at least 4 hours after the procedure. It is best not to lie down immediately.

• Do not rub or massage the treated area. The drug may spread to unwanted areas.

• Refrain from saunas, intense exercise, and alcohol consumption for 48 to 72 hours.

And it is also important to have realistic expectations. The goal of under-eye Botox is not an 'under-eye area with absolutely zero wrinkles,' but a naturally softened impression. Weakening the muscles so excessively that even facial expressions become awkward is rather unnatural, and you could lose good structures like your natural under-eye roll.

If symptoms such as diplopia (double vision) occur after the treatment, this is not something to wait out but a sign that you must seek immediate medical attention.

📌 Key Summary: Keeping upright for 4 hours, avoiding rubbing, and refraining from saunas, exercise, and alcohol for 48 to 72 hours are basic rules. Set natural improvement as your goal, and seek immediate medical attention if abnormal symptoms like double vision occur.

❓ Frequently Asked Questions (FAQ)

Will under-eye Botox make my under-eye roll (aegyo-sal) disappear?

If an appropriate dose is injected in the exact location, you can soften wrinkles while maintaining your under-eye roll. However, if the dose is excessive or the injection site is inaccurate, the under-eye roll may diminish, so it is crucial to discuss and confirm the preservation of your under-eye roll during the pre-procedure consultation.

Can dark circles be improved with Botox?

It depends on the cause of the dark circles. The effect of Botox is limited on pigmented, vascular, or structural (hollow) dark circles. It is recommended to choose or combine treatments that match the cause, such as lasers for pigmentation, fillers for hollows, and skin boosters for skin quality.

Can I immediately reverse side effects if they occur?

Unfortunately, there is no immediate way to reverse Botox like fillers. You have to wait for the effects to wear off naturally over time, so a cautious approach of starting with a small dose and making touch-ups after seeing the results in 2 weeks is the safest path.

I have bulging under-eye fat. Can I still get Botox?

In many cases, it is difficult to recommend. This is because weakening the orbicularis oculi muscle can actually make the protrusion of under-eye fat more prominent. In this case, treating the fat itself may address the root cause better, making prior diagnosis essential.

I have dry eye syndrome. Is it okay to get the treatment?

Caution is required because a decrease in the orbicularis oculi muscle's function can affect tear film distribution and eye closure. You must inform your doctor of your dry eye syndrome before the treatment, so that the possibility of the procedure and the dosage can be adjusted according to your condition.

Will I develop resistance if I keep getting the injections?

Although the possibility of antibody formation is rarely mentioned with repeated procedures, clinical reports suggest that keeping appropriate intervals and receiving consistent treatments can actually prolong the duration of the effects. It is recommended to keep the re-treatment interval to at least 3 to 4 months.

Under-eye wrinkle Botox: Things to check before choosing a clinic

Even for the same procedure, the results and recovery process will vary depending on where, by whom, and how it is performed. Asking these questions directly during your consultation will help you make a decision.

• Is this a procedure they perform frequently? — Every clinic has different procedures they focus on. Check if they regularly perform under-eye wrinkle Botox.

• Can you verify the products and equipment used? — Ask if you can verify the product name and whether it is genuine (whether it is an import-approved product and if there is a process to confirm its opening) during the consultation.

• Do they explain the breakdown of the cost? — Rather than just hearing the total amount, you need to hear an explanation of what product is used, how much, and on which areas to make an informed decision.

• Do they design the treatment while looking at the whole face? — Even for the same procedure, the injection points and amount vary depending on the face shape, skin condition, and left-right asymmetry.

• Do they explain adverse reactions and the recovery process first? — A clinic that informs you of potential adverse reactions and coping methods is a better place to make a decision than a consultation that only talks about the expected changes.

• Is there a follow-up pathway after the procedure? — Check if the timing for checking progress, how to contact them if there is an issue, and revisit criteria are established.

How Onlif Clinic performs under-eye wrinkle Botox

• We divide responsibilities — With the belief that a single doctor cannot handle all procedures, Onlif divides medical treatments among doctors responsible for each specific field.

• We verify products and equipment together during the consultation — We guide you through the products used and the opening confirmation process during the consultation.

• Pricing is presented along with the treatment plan after diagnosis — Since the area, dosage, and scope vary from person to person, we explain what is being used and how much it costs together.

• We design treatments looking at the overall balance of the face — We view the face through three axes—texture, balance, and signals of youth—and make plans with a focus on cleaning up areas that mask your natural impression rather than altering your features.

• We discuss adverse reactions and the recovery process first — Along with the expected changes, we guide you through individual differences, potential adverse reactions, and countermeasures before the procedure.

• We review the progress together after the procedure — If checks are needed during the recovery period, we provide guidance on follow-up visits and contact channels.

If you are considering under-eye wrinkle Botox, it is best to first check what is possible and what is difficult in your current state. An accurate diagnosis and treatment plan can only be determined through an in-person consultation. Find out through a consultation at Gangnam Onlif Clinic.