Thank you for your question.
Botox is typically used for wrinkles in the forehead, frown lines and crows feet (the smile lines that appear beside the eyes). There are some people that have used botox below the eyes; however, that is an off label use that must be approached with extreme caution. The muscle that is being targeted is the orbicularis oculi muscle, and is the muscle responsible for tone in the lower eyelid. If that muscle is inappropriately weakened through a paralytic like botox, it may result in a functional deformity where the eyelid recedes away from the eye and turns outward known as ectropion. This is a serious condition that is a difficult problem to fix and has significant morbidity. I would suggest avoiding botox underneath the eyes for this reason. If you have significant wrinkles or puffiness in this area, perhaps a lower blepharoplasty, or lower lid lift may be the right procedure for you. This is something that should be discussed with a board certified Plastic Surgeon.
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