Botox crow’s feet: why, how and with which toxin?

Crow’s feet are one of the eleven areas of our guide to botulinum toxin, area by area. Together with frown lines and the forehead, they are one of the three areas for which type A toxins have an aesthetic indication in France. This page explains how they are treated, with which toxins and with what risks. It does not replace a consultation.

Why are crow’s feet treated?

Crow’s feet are fine lines fanning out from the outer corner of the eye. The labels call them "lateral canthal lines" or "lateral periorbital lines"^1,3. They show when you smile, because the orbicularis oculi, a ring of muscle that surrounds the eye and closes it, creases the skin at the corner of the eye.

Botulinum toxin temporarily relaxes the outer part of this muscle. The creasing is less marked when you smile, and the lines deepen less. The labels describe injection at a few points on each side, into the muscle, just under the skin, to limit the spread of the toxin³.

What the toxin does not do: it does not correct under-eye bags or dark circles, or fine lines related to skin quality that remain visible without any movement. Nor should it reach the eyelid: the page on injections near the eyelids explains why this neighbouring area is protected.

When is the toxin used?

The labels concern moderate to severe crow’s feet seen at a full smile, when their severity has an important psychological impact, in adults^1,2,3,4. Crow’s feet can be treated alone or at the same time as frown lines or the forehead; the labels describe these combined treatments¹.

The labels contraindicate injection in case of allergy to the toxin or to a component of the product, a generalised disorder of the muscles and of the junction between nerve and muscle (myasthenia gravis, Lambert-Eaton syndrome), or an infection at the injection site^1,2,3. Treatment is not recommended during pregnancy or breastfeeding¹.

Which toxin for crow’s feet?

Depending on the product: not every type A toxin approved for aesthetic use covers this area.

Several type A toxins are approved for this area in France, but not all of them: some cover only frown lines^1,2,3,4. Your doctor chooses the product taking these indications into account, as well as your age, since several of them are indicated only before 65^2,3,4.

The short-acting botulinum toxin (serotype E) is approved for frown lines only, in the European Union and in Canada: crow’s feet are not part of its marketing authorisation^5,6. Using it in this area would be off-label and has not been evaluated in its trials⁵.

Is it right for me?

Your doctor will look at your lines at rest and when you smile, the quality of your skin, and the position of your eyelids and cheekbones. They will take into account your medical history, in particular dry eyes or eyelid surgery, your treatments and any pregnancy plans.

Age matters: several toxins approved for this area are indicated only in adults under 65^2,3,4, and data are limited after 65 for another one¹.

Questions to ask your doctor: should frown lines or the forehead be treated too? Could my smile change? I have dry eyes: is that a problem? How long should the effect last?

Onset and duration

For the type A toxins approved for crow’s feet, improvement appears in the first few days (within 6 days according to one label), the peak effect is seen around day 30, and the effect lasts up to about 4 months^1,3, with a median duration of 4 months according to one label¹. For one of the approved toxins, the effect has been shown for 6 months⁴. Sessions are at least 3 months apart^1,3.

To understand these different stages, see the page on how long botulinum toxin takes to work.

What are the risks in this area?

For crow’s feet, the labels describe small bruises at the injection site, eyelid swelling, dry eyes, headaches, and also a drooping eyelid or a temporary weakness of a facial muscle close to the injection points, classed as common in one of them^1,2,3. One label asks to avoid injecting too close to the zygomaticus major to prevent the lip from drooping, which would change the smile³. These effects are temporary.

The neighbouring forehead area has its own risks, covered on the page about forehead lines; so does the nose, just inwards, on the page about bunny lines on the nose.

Difficulty swallowing, speaking or breathing requires immediate medical attention^1,3. A visual disturbance should also be checked by a doctor promptly. If something unexpected happens, such as dry eyes or a changed smile, the page on the eyes and crow’s feet after an injection helps you recognise it.