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Botulinum toxin injection works well and reliably in crow’s feet, glabella, and forehead. With experience, the eyebrows may be repositioned through treatment of the adjacent orbicularis oculi, procerus, corrugator supercilii, and depressor supercilii. Dose is often individualized and may be related to muscle mass.

Crow’s feet injection is one of the simplest and most satisfying applications of botulinum toxin. The radiating dermal crow’s feet lines result from the concentric constriction of the underlying orbital and preseptal orbicularis oculi muscle. Orbicularis oculi injections of botulinum toxin diminishes both active and static crow’s feet rhytids, may prophylactically delay the onset and progression of such wrinkles, and improves final outcome following ablative periocular resurfacing.

Botulinum toxin is currently the most popular aesthetic procedure for men and women. The upper third of the face is frequently treated. The risks and complications of treating three areas above the zygomatic arch are discussed. Combining fillers with toxin in these areas often provides the most successful results. Precautions about treatment and methods to avoid complications are addressed.

Crow’s feet injection is one of the simplest and most satisfying applications of Botox. The radiating dermal crow’s feet lines result from the concentric constriction of the underlying orbital and preseptal orbicularis oculi muscle. Orbicularis oculi injections of Botox diminshes both active and static crow’s feet rhytids, may prophylactically delay the onset and progression of such wrinkles, and improves fi nal outcome following ablative periocular resurfacing (Figure 106.1). Since the thin periocular skin is prone to visible bruising, injection should be in the subdermal plane while avoiding actual intramuscular injection. The loose periocular subdermal plane in the area of crow’s feet rhytids should visibly balloon up when the injection is delivered at the proper depth. Following injection, the patient may apply pressure for 1–2 minutes over the injection sites to minimize bruising.