Fine Lines Under Your Eyes: Why Botox Usually Isn’t the Answer

Most fine lines under eyes come from thin, sun-exposed skin rather than from a muscle folding the skin, and that changes which treatment works. In this guide I explain how to tell the two apart at home, why Botox is rarely my first choice directly under the eye, and what the research supports instead.

Crow’s feet and under-eye lines are different problems

Crow’s feet are mainly movement lines, while lines directly under the eye are mainly a skin-quality problem. Crow’s feet fan out from the outer corner of the eye because the ring-shaped muscle around the eye, the orbicularis oculi, squeezes the skin every time you smile or squint. Botox relaxes that muscle, which is why crow’s feet respond so well to it.

The skin just below the lower lashes is a different story. It is among the thinnest skin on the body, it gets sun every day, and as it loses collagen and elasticity it develops a fine, crinkled, crepey texture. Those lines are there even when your face is still. Botox treats movement. It does not thicken skin or improve its texture, so for lines that are mostly a skin issue it has little to work on.

A quick way to tell which you have

You can sort most under-eye lines yourself in front of a mirror in natural light.

1. Smile widely. Note where the lines appear and how deep they are.
2. Relax your face completely. Let your cheeks and eyes go soft and look straight ahead.
3. Compare. If the lines mostly disappear at rest and are clearly tied to smiling, they behave like crow’s feet extending downward, and those can respond to a neuromodulator. If fine lines or crepey texture are still there with your face relaxed, you are looking at a skin-quality problem.
4. Check for shadow and puffiness. A groove that casts a shadow is a hollow, and a bulge is usually fat or fluid. Neither is a line, and each has its own treatment.

Why Botox is rarely the first answer under the eye

Botox is approved for crow’s feet, not for the lower eyelid, and the lower lid needs its muscle tone. The Botox Cosmetic prescribing information lists four approved uses: lines between the brows, lateral canthal lines (crow’s feet), forehead lines and platysma bands in the neck. Injecting directly under the lower lashes is off-label. In the crow’s feet trials, the most common side effect was eyelid swelling, in 1 percent of patients, and that was with injections placed at the outer corner of the eye rather than under it.

The same orbicularis oculi muscle that creates crow’s feet also closes the eye and helps hold the lower lid against the eyeball. If too much of it is relaxed under the eye, the lid can lose support. That can make under-eye puffiness more noticeable, and in someone whose lid is already loose it can affect how well the eye closes. A very small off-label dose is sometimes used in carefully selected patients whose lines are clearly movement-related and whose lower lid is firm, and it should not be the main treatment for crepey skin.

A bulge of muscle that appears under the lashes when you smile, sometimes called a jelly roll, is a separate concern. I cover it in my guide to jelly roll Botox.

What helps lines that come from skin quality

Skin-quality lines respond to treatments that build or protect the skin itself, and they work over weeks and months rather than days.

A retinoid made for the eye area

Retinoids are a standard topical treatment for fine lines, and gentler formulas are made for the under-eye. In a 12-week study in the Journal of Drugs in Dermatology (Kaufman and colleagues, 2022), 16 adults who used a hydrating retinoid eye cream every night saw lines and wrinkles improve by an average of 33 percent and texture by 37 percent, with no product-related side effects reported. The study was small, had no control group, and several authors worked for the manufacturer, so I treat it as encouraging rather than proof. I recommend starting two or three nights a week and building up, because under-eye skin irritates easily.

Daily sunscreen

Sun protection prevents new lines more reliably than any treatment reverses old ones. In a randomized trial of 903 adults in the Annals of Internal Medicine (Hughes and colleagues, 2013), people who applied sunscreen every day showed no detectable increase in skin aging over four and a half years, and 24 percent less aging than people who used it only some of the time. In Arizona, I recommend taking sunscreen right up to the lower lash line, where it is easy to miss, and wearing sunglasses so you squint less.

PRF injections

PRF (platelet-rich fibrin) is made from your own blood and injected into the under-eye skin to support skin quality. A 2025 systematic review of 14 studies in the Journal of Cosmetic Dermatology found that PRF “shows promise in improving periorbital texture and fine lines,” with mostly short-lived swelling, redness and bruising. The authors rated the evidence low to moderate and noted that improvements often fade by six months. A small 2023 trial in Dermatology Practical and Conceptual (Ahmadi Mahmoodabadi and colleagues) reported improvement in fine wrinkles and skin freshness 12 weeks after PRF matrix injections around the eyes, with swelling lasting up to one day. A common approach is to plan PRF as a series and pair it with skincare.

When the problem is not lines at all

Sometimes what looks like “lines” is mainly a hollow or puffiness, and those need a different plan. A hollow that casts a shadow may be a candidate for filler or PRF EZ Gel, which I compare in my guide to under-eye fixes. Before choosing filler in this delicate area, read about the risks of under-eye filler. Puffy bags are usually fat or fluid, and neither Botox nor filler is the right tool for those.

What it costs at KORA

Prices come from our current price list. Your plan and total are confirmed at a complimentary consultation before anything begins.

Learn more about PRF injections and medical-grade skincare at our clinic on the Scottsdale and Paradise Valley border.