Crow's feet

The fan-shaped lines beside the eyes are produced by the orbicularis oculi, the ring muscle that closes the eye. It works with every blink, every laugh and every squint against light or wind. The skin here is the thinnest on the face and has almost no subcutaneous fat — which is why it shows movement earlier than any other area.

What treatment can achieve — and what it cannot.

What is treated is the movement-dependent part: the lines that appear when you laugh and blink. They flatten because the ring muscle contracts less strongly. What is not treated is the part caused by sun damage, collagen loss and thinning skin. Fine crepey lines that remain visible with the face completely relaxed respond only to a limited degree — those are a question of skin quality, not muscle activity.

This is the most common source of disappointed expectations in this region. So the consultation begins by working out which part is movement and which is structure. For the structural part, other methods come into consideration — skinboosters, polynucleotides or PRP, alone or alongside.

How the treatment works.

The medication is placed in small amounts very superficially into the outer part of the ring muscle, keeping a safe distance from the lid margin and the cheekbone. For a limited period the muscle contracts more weakly and the skin above it creases less. The ability to close the eye is unaffected.

Side effects — named honestly.

Small bruises are more common here than elsewhere because the skin is thin and well supplied with blood; they usually fade within a few days and can be covered. A temporarily altered sensation when smiling is possible and, rarely, an asymmetric smile if the substance spreads towards the cheek muscles. Very rarely there is increased watering or dryness of the eyes. All effects are temporary; a residual risk cannot be excluded entirely.

When treatment is not the right answer.

If the lines are largely visible at rest as well, if there is marked laxity of the lower lid skin, or if you have known dry eye. Where there is pronounced volume loss in the temples and cheeks the effect is also limited — there it is the frame that has changed, not the line.