Hi Dr. Yang,
Are there any permanent solutions for crow’s feet?
Crow’s feet form mainly from 3 factors, repetitive muscle activity (squinting), loss of elasticity to the skin around the eyes, and some fat loss in the area, causing the outer brow to sag down and form some crow’s feet.
There are no “permanent” solutions, but there are some remedies. The first line of defense and gives the fastest improvement is Botox. By paralyzing the muscles that squint, the crow’s feet can dramatically improve and if they were mainly occuring with motion, this will look the best. For static, or crow’s feet which are there at rest, without squinting, then there has been loss of skin elasticity as well as the configuration (shape of the brow area). The non-surgical approach is to improve the skin. The skin needs to be more elastic as it was in youth so that the skin that forms the crow’s feet is more “springy” and is less likely form creases. Imagine the area behind knee on a pair of leggings or stockings (which have lots of elasticity) versus a pair of linen pants which don’t have any elasticity, and forms lots of wrinkles behind the knee area. The reason it doesn’t form wrinkles is that when you bend your knee the skin “shrinks” or “snaps back” to tighten any loose skin so it doesn’t’ fold and form a crease. Laser treatments and chemical peels can improve deeper crow’s feet, and the healing process can induce (cause) collagen growth, but I don’t know if it causes Elastin (the springy fibers which is not collagen) to form. Since chemically burning the skin, or using a laser to burn the skin in a controlled manner may not improve elasticity, I am using the Obagi Elastiderm (Night Eye cream) on my patients since they do have some scientific papers which shows that it does work. It is low risk, and relatively inexpensive compared to all of the other options.
The last resort which may actually be what you are referring to as permanent is a browlift, but mainly the temporal or lateral browlift which lifts up the corner the eyebrow and “stretches” out the skin in this area which makes the crow’s feet which are visible at rest look better. You can try this at home. Lift up your eyebrows or with your finger, you can push up on the outer eyebrow to see if the crow’s feet get better. Most likely it will. The dilemma is whether or not your eyebrows were this high normally or in youth. So this ends up being a solution for static crow’s feet (at rest) but may create an unnatural appearance, unless performed subtly, in which case, a small amount of crow’s feet may be left.
There are no perfect solutions, there are Pro’s and Con’s to each one. Botox is nice and low risk, but can add up over time. The skin creams can help but may not be dramatic enough. Skin resurfacing can also help, but have the risks of lasers/chemical peels. And a temporal/lateral browlift (included in a regular browlift) is real surgery, and changes the heighth of the brow, but can help the crow’s feet the most.
For the maximal results, some surgeons may perform the browlift, with laser or chemical peel, with medical grade skincare (like OBAGI), and also inject Botox to minimize movement in this area every 3-4 months.
I hope this answers your question.