Botox Around the Eyes: Uses, Risks and Costs

Botox treatments are a relatively inexpensive way to get rid of unwanted wrinkles and lines around the eye and in the forehead.

The treatment involves one or a series of injections of botulinum neurotoxin (BNT) directly into the skin. It is effective in relaxing muscles and muscle contractions, which create lines and wrinkles.

The chief risk of Botox is that it can spread to other areas and have unwanted effects.

Intro

The ability of Botox to smoothen out facial wrinkles makes it a popular anti-aging agent in the cosmetics industry. But this botulinum toxin-containing agent has both cosmetic and medical applications.

Medical professionals also turn to Botox for treatment of cervical dystonia (neck spasms), nerve pain, bladder hyperactivity and excessive sweating.

When talking about the face, in addition to facial wrinkles botox can be used around the eye to treat conditions like blepharospasm, known as eyelid twitching, and crow’s feet.

Onobotulinum toxin type A is the active ingredient in Botox. While Botox is the most popular botulinum toxin-containing agent used around the eye, doctors also treat patients with drugs such as Dysport, Xeomin and Myobloc, which have different forms of the toxin.

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Cosmetic Uses for Botox around the Eyes

Proper use of Botox brings about a youthful appearance. Although some uses are not yet approved by the U.S. Food and Drug Administration (FDA), using Botox to reduce crow’s feet, glabellar and forehead lines are approved and effective. You may need multiple Botox injections to achieve the desired level of appearance enhancement.

Crow’s Feet

Crow’s Feet, or lateral canthal rhytides, are skin folds that occur on the outer corner of the eye because of partial dysfunction of periocular muscles. Smiling exaggerates the lines you see.

Because of the nature of muscles involved in crow’s feet, the number of Botox injections you require is more than other cosmetic procedures.

Glabellar Lines

Glabellar lines are wrinkles that form in the upper face between and above your eyebrows. Folds are more prominent when you frown but can be present at rest. They result from the contraction of the muscles, which move the brow laterally and downwards.

An injection of Botox cosmetics around the forehead reduces the wrinkles for about three months.

Forehead Lines

Lifting the brow usually causes the formation of creases on the forehead. But the folds can also form with an intrinsic contraction of the frontalis muscles giving you forehead lines. Botox eliminates these wrinkles too.

Other approved cosmetic uses of Botox around the face include non-surgical brow lift, reduction of bunny lines, treatment of prominent indentation lines from the nose to the edge of the mouth and wrinkles that spread out from the mouth.

Medical Uses for Botox Around the Eyes

The FDA has also approved Botox for treatment of multiple medical conditions including, strabismus (lazy eye) and blepharospasm (eye twitching). 

Strabismus

Commonly referred to as a lazy eye, strabismus comes from an imbalance in the strength and coordination of muscles that move the eyes. Muscles in the eye work as a team to move the eyes in the same direction and allow you to focus on one object.

With strabismus, eyes look in different directions. Consequently, each eye sends a different signal to the brain. The brain tends to interpret signals from one eye and ignore the other.

In most cases, damage to the nerves supplying the extraocular muscles is the cause of lazy eye rather than muscle weakness. Crossed eyes, double vision, and loss of depth perception are some of the symptoms. 

Doctors use Botox injections to treat strabismus when eye patching and eyeglasses, two other ways of correcting the condition, fail.

Blepharospasm

Doctors also turn to Botox injections when the eye muscles twitch involuntarily and interfere with vision. Many people experience mild, episodic eye twitching that feels like a tug on the upper or lower eyelids. These cases do not require any treatment.

But when the symptoms are chronic and intense, with a considerable impact on your vision, Botox can relieve the twitching. Blepharitis, photophobia, dry eyes and conjunctivitis can worsen the twitching creating the need for Botox.

How Botox Works

When injected, the botulinum toxin blocks nerve signals that initiate muscle contraction so the muscles relax and reduce facial wrinkles.  The effect usually wears off in three-to-six months, and muscles contract again. That is why you need multiple injections of Botox to eliminate wrinkles. 

What to Expect

Getting a Botox injection, or multiple injections, does not require much in the way of prep. And the procedure itself is fast and straight forward. Pain or discomfort comes in the form of sharp but minor stinging.

Before the Procedure

Your doctor might numb your skin using topical anesthetic or ice to reduce discomfort during the procedure. However, most people do not need numbing as the procedure has minimal pain.

During the Injection

Botox injections are done in a doctor’s office with the procedure lasting only a few minutes. The doctor will use a thin needle to inject small amounts of Botox into your muscles or skin.

The dosage of Botox needed depends on the severity of the condition.

Recovery

Botox can spread to other areas beyond the injection site and cause adverse effects such as ptosis, a drooping upper eyelid.

That is the reason doctors advise you not to rub the treated areas for at least four hours after the injection to reduce the risk of side effects. Your doctor might recommend avoiding exercise for 24 hours after receiving an injection.

Effectiveness

Botox effectively reduces wrinkles caused by abnormal contraction or aging. The injections begin to work within 72 hours of administration, with the effect peaking at two weeks.

The Botox effect wears off in three to six months. But you may require multiple follow-up injections to maintain the desired outcome. Doctors can increase your dosage if smaller doses don not insufficiently get rid of undesirable wrinkles or lines.

Side Effects

Botulinum toxin can spread from the site of injection to other body parts leading to undesirable effects. Possible side effects of Botox injection include:

• Difficulty swallowing and breathing
• Generalized muscle weakness
• Incontinence
• Slurring of speech
• Visual disturbances
• Ptosis
• Ulceration of the cornea following blepharospasm treatment
• Retrobulbar bleeding in strabismus
• Hypersensitivity reaction in some people.

Costs

The cost of a Botox injection is calculated per unit. Typically, one unit costs between $10 and $15. The dosage you need depends on the area being treated.

For instance, the forehead wrinkles can need 30 to 40 units for full treatment. That brings the total cost to about $300 to $600. Prices vary depending on your state and your doctor.

Insurance and Botox

For now, medical insurance companies consider all Botox treatments to be cosmetic. As with other cosmetic procedures, insurance does not cover any part of the cost of the procedure.

However, doctors and patients are pushing back because research has started to point to Botox treatments as a treatment for maladies that have nothing to do with appearance, such as nerve pain. If more data surfaces that points to Botox as a safe and effective procedure for these conditions, there will be pressure to have some insurance coverage.

Because Botox is approved to treat chronic migraines, many insurance plans, including Medicare and Medicaid, do pay for this. Allergan, the manufacturer of Botox, also supplies recipients with discount cards to offset the cost.

Alternatives

Botox injection was the first botulinum toxin agent to be approved for cosmetic and medical use by the FDA. However, alternatives that contain other modified forms of neurotoxin now exist.

Alternative drug injections include Dysport, Xeomin and Myobloc.

Other non-drug alternatives to Botox include acupuncture, vitamins, face patches and face creams.

References

1. Botox Medication Guide. (August 2011). Allergan Pharmaceuticals Ireland.

2. Botulinum toxin for the treatment of strabismus. (March 2017). Cochrane Library.

3. How Does Botulinum Toxin (Botox) Work? (March 2021). American Academy of Ophthalmology.

4. Botox injections. (February 2021). Mayo Clinic.

5. Botulinum Neurotoxin Injections. Dystonia Medical Research Foundation.

6. Botox for Migraine. American Migraine Foundation.

7. Botox Eases Nerve Pain in Certain Patients. (June 2010). Johns Hopkins Medicine.