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Botox
Is fat or Botox better for crow's feet? Can I inject fat over Botox on crow's feet?
As others have mentioned, the cause of "crow's feet" is from muscular contraction of the orbicularis oculi muscles. Since the muscle is superficial and the skin is relatively thin, the wrinkles tend to be noticeable, especially if you have improved the appearance of the surrounding tissue. Botox or Dysport treatment are ideal for that area to weaken/prevent muscle contraction in the area to soften or efface the wrinkles. Adding volume (fat) may result in noticeable puffiness or lumpiness due to the thin skin in the area without improving the wrinkles when smiling because the muscle activity will still be intact.
Clinical Context
Botox and fat carry different kinds of risk near the eyes. Botox can occasionally spread slightly beyond the treated muscle, which may cause temporary eyelid heaviness or asymmetry that fades as the effect wears off. Fat grafting is longer-lasting, so because the skin here is thin, any lumpiness or unevenness is more noticeable and harder to smooth out than a toxin effect that simply fades. Talk with your surgeon about your skin thickness and goals before choosing between the two.
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