Smile lines around the eyes: should they go?
Plenty of people dislike the lines that catch at the corners of their eyes when they smile. But I do not want to erase all of them. Let me set out why, and how far it makes sense to reduce them.
The short answer
Eye-corner lines that appear only when you smile are expression lines folded by the muscle around the eye, so botox can reduce them. They are not a disease that has to go, and how much to reduce them is your choice. In a phase 3 trial of 417 people in China, 63.9% reached the none or mild grade for smile lines at day 30, against 5.0% on placebo. But fine lines that stay without smiling and under-eye hollows are not muscle problems, so botox does not change them. Creams are for fine lines and texture. At Miso Clinic, 4F Bombom Building, 125 Dongdeok-ro, Jung-gu, Daegu (Exit 1, Kyungpook Nat'l Univ. Hospital Station), +82-53-428-2700, I look at your smiling face and your resting face separately.
Why do lines form around the eyes when I smile?
The muscle that circles the eye (the orbicularis oculi) tightens when you smile and folds the skin at the corner of the eye. Everyone makes this movement. When you are young, the lines vanish once the smile stops. As the skin thins and sun exposure builds up, they gradually start to stay even at rest.
This is why I do not try to erase these lines entirely. The eye area moving along with a smile is part of the expression. If the mouth smiles and the eyes do not move, it can look awkward. That is my clinical judgement.
What kind of eye wrinkles do I have?
| How it looks | What kind of wrinkle | Look at first |
|---|---|---|
| A fan at the eye corner only when smiling | Expression lines | Botox |
| Stays at the eye corner even without smiling | Expression lines that have left a mark | Botox + a discussion of dermal treatment |
| Crinkly under the eye, worse when dry | Fine lines in thin skin | Sun protection, moisturiser, dermal injection |
| Hollow and shadowed under the eye | Hollowing, a groove | Judged separately from fine lines |
What people mix up most often is smile lines and under-eye fine lines. They are in the same eye area, but the reasons differ. I have written about under-eye fine lines separately.
→ More: Under-eye lines in Daegu
How well does botox work around the eyes?
There are two phase 3 trials in Asian people. In the 417-person trial in China, the none or mild grade when smiling at day 30 was 63.9% against 5.0% on placebo, and the median duration of effect was 5 months or more. In the 300-person trial in Japan, the two doses gave 68.3% and 56.6% against 8.2% on placebo. Both were run by the manufacturer, so in actual practice I generally reckon on 3 to 4 months.
In the meta-analysis pooling adverse reactions, the eye area was 1.13 times placebo, a smaller gap than the forehead (1.53 times) or glabella (1.42 times). Still, it is a spot that bruises easily, because the skin is thin and there are many small vessels.
There is a single case in which the inner under-eye area looked dimpled when smiling, 4 weeks after eye-area botox. Muscles are intertwined, so reducing one can change the one beside it. One case cannot tell us how often this happens. That is why I look at your smiling face again at 2 weeks.
Do eye wrinkle creams work?
I cannot say they do nothing. In a study that randomised 196 women with eye-area wrinkles for 8 weeks, a cosmetic regimen of niacinamide, peptides and retinyl propionate improved wrinkles more than a tretinoin 0.02% regimen, and in the groups of 25 each who continued to 24 weeks the results were similar. But this was a cosmetics company’s study. I could not find a study comparing eye creams with one another.
What I do urge is sunscreen. In a trial that followed 903 people for 4.5 years, those who applied it daily had 24% less skin ageing. The eye area is easy to skip for fear of getting it in your eyes, which is all the more reason to take care of it. Retinoids tend to irritate around the eyes, so use less and start little by little. They are not used in pregnancy.
A cream does not stop the movement that folds the lines when you smile. Set your expectations here and there is less to be disappointed about.
Are there cases where you would not recommend eye-area botox?
- When the main concern is under-eye hollowing or thinned skin, because that is not a muscle problem
- When it has been less than 3 months since the same area was treated
- During pregnancy or breastfeeding, with a neuromuscular disease such as myasthenia gravis, or with inflammation at the injection site
- When you want no smile lines left at all, because it can look awkward, so we decide again together
→ More: Under-eye lines in Daegu
Smile lines around the eyes: frequently asked questions
Can smile lines around the eyes be removed?
Botox can reduce them a lot. In a 417-person trial in China, the none or mild grade at day 30 was 63.9% against 5.0% on placebo. But they are part of your expression, so I do not aim to erase them all.
Will eye-area botox improve under-eye lines too?
No. Under-eye hollows and fine lines in thin skin are not movement problems, so botox does not change them. They are judged separately.
Do eye wrinkle creams work?
You can expect something for fine lines and texture. There is a 196-person randomised study, but it was a cosmetics company’s study. Creams cannot stop the movement that folds the lines when you smile.
Where can I get a eye wrinkle consultation in Daegu?
At Miso Clinic, 4F Bombom Building, 125 Dongdeok-ro, Jung-gu, Daegu (Exit 1, Kyungpook Nat'l Univ. Hospital Station), +82-53-428-2700. Weekdays 11:00–19:00, Saturday 10:00–16:00, closed Sundays and public holidays.
Read next
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Related treatments: Botox: when it starts working and how long it lasts · Types of facial wrinkles
Who wrote this
Written and reviewed by Lee Chi-Hak, MD, director of Miso Clinic, Daegu. The treatment standards and injection design set out here are the ones we use in practice.
| Medical director | Lee Chi-Hak, MD |
|---|---|
| Address | 4F Bombom Building, 125 Dongdeok-ro, Jung-gu, Daegu, South Korea · Exit 1, Kyungpook National University Hospital Station |
| Phone | +82-53-428-2700 |
| Hours | Weekdays 11:00–19:00 (lunch 13:00–14:00) / Saturday 10:00–16:00 (no lunch break) / Closed Sundays and public holidays |
| Columns | All clinical columns |
| Reference library | All booster and device references |
References
- Phase 3 crow’s feet trial (China) — Wu Y et al. Plast Reconstr Surg Glob Open 2019;7(1):e2079. PMID 30859038. 417 people. Authors include manufacturer employees.
- Phase 3 crow’s feet trial (Japan) — Harii K et al. Aesthetic Plast Surg 2017;41(5):1186-97. PMID 28733805. 300 people. Authors include manufacturer employees.
- Meta-analysis of botox adverse reactions — Zhang W et al. Meta-Analysis of Adverse Reactions of Botulinum Toxin A in Facial Rejuvenation Treatment. Aesthetic Plast Surg 49(9):2305-14 (online December 2024). PMID 39623228. 20 randomised trials.
- Case of under-eye dimpling after eye-area botox — Escobar S et al. J Cosmet Dermatol 2025;24(12):e70534. PMID 41277724. A single case.
- Randomised comparison of eye-area wrinkle creams — Fu JJJ et al. Br J Dermatol 2010;162(3):647-54. PMID 20374604. 196 women with periorbital wrinkles, 8 weeks (some 24 weeks). A cosmetics company (P&G) study.
- Randomised sunscreen trial — Hughes MCB et al. Ann Intern Med 2013;158(11):781-90. PMID 23732711. 903 people, 4.5 years.
- Korean medical advertising law — Korean Medical Service Act Article 56(2) (no treatment testimonials, no comparisons with other clinics, no superlatives). This is why this column carries no prices, reviews, before-and-after photos or doses.
- Miso Clinic practice guidelines — Miso Clinic botox materials: target muscles by area; lines sorted by having you make expressions; dose planned by muscle size, strength and left-right difference; review at 2 weeks; at least 3 months between sessions in the same area; approved uses explained first.
Everything in this column is general information and does not replace medical diagnosis or treatment. Effects and side effects vary with individual skin condition, age and underlying illness, and the same result is not guaranteed for everyone. Any decision to proceed should be made in an in-person consultation with a physician.