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Chapter 4. Crow's Feet

Crow's Feet Anatomy

Crow's feet are lines that form in the lateral canthal region and are caused by contraction of the orbicularis oculi muscle.

The orbicularis oculi muscle constricts the skin around the eye, reducing the eye opening and closing the eye. The muscle has 3 components: orbital, palpebral, and lacrimal, each of which varies in size from patient to patient. The outer part originates in the medial part of the orbit and runs around the eye via the upper eye cover fold and lid and returns in the lower eyelid to the palpebral ligament. The palpebral part originates in the palpebral ligament and runs above and below the eye to the lateral angle of the eye. The 2 muscles form concentric circles around the eye. Action of the palpebral part is often involuntary, as in the blink reflex.

(Video courtesy of Sergio Talarico, MD, Dermatologist, Sao Paulo, Brazil.)
This video is a 3-dimensional animation demonstrating the muscle action of the orbicularis oculi.

(Adapted with permission from Ipsen.)

Crow's feet are lines that form in the lateral canthal region and are caused by contraction of the orbicularis oculi muscle (shown in yellow), though skin changes from aging and contraction of the zygomaticus may contribute. The blue oval in the illustration indicates the approximate appropriate injection zone area for neurotoxin treatment of this muscle. The muscle is shaded in yellow in the illustration.

It is important to determine the cause of rhytid formation to identify the best approach to treatment of crow's feet.

Crow's Feet Case

Reducing crow's feet when smiling.

Here is a 47-year-old, physically active Caucasian male, previously treated with aesthetic neurotoxin, who wants to reduce his crow's feet wrinkles when smiling.

Patient assessment is critical to making an individualized treatment plan. The practitioner determines the source of the wrinkles - the orbicularis oculi vs zygomaticus major - when assessing the wrinkles while the patient animates and while he is at rest. Evaluation should include a "snap test" to measure skin laxity along the lower lid margin. Skin that does not snap back into place after downward tugging may not respond well to neurotoxin treatment and be at higher risk for ectropion.

Crow's Feet Treatment Approach

Reducing dynamic rhytides and softening static rhytides is the goal.

The goal of treatment for a 47-year-old while male who wants to reduce his crow's feet wrinkles while smiling is to reduce dynamic rhytides and to soften static rhytides. The patient was injected in each of the 3 blue circles (photo) on each side with 15 DYSPORT Units. The red X marks an optional injection point that some practitioners may choose to add to treatment plan.

Crow's Feet Injection Demonstration

The patient received a total of 90 DYSPORT Units to treat the crow's feet, 45 DYSPORT Units per side via 3 injections per side, 15 Units per injection.

Crow's Feet Results

Smiling without crow's feet wrinkles.

Patient depicted 17 days after DYSPORT treatment for crow's feet. The patient also received DYSPORT treatment of the glabella and forehead at same visit.

Patient alternates expression from rest to smile 17 days after treatment with DYSPORT. He has a nice effacement of the rhytids, with less pulling down of the brow and some motion maintained.

Crow's Feet Treatment Summary

Crow's feet treatment with neurotoxin is easily integrated into upper face enhancement once the cause of wrinkling is determined. Aging skin and its attendant photo damage, skin excess, eye bags, and volume deficit may require a combination of therapies.

Evaluation should include a "snap test" to measure skin laxity along the lower lid margin. Skin that does not snap back into place after downward tugging may not respond well to neurotoxin treatment and be at higher risk for ectropion.