Patients display individually unique crow’s feet lines, and deeply etched in wrinkles and treatment with botulinum toxin analogues must be tailored to each case. For the most part, lower botulinum toxin doses produce a more animated result, while higher doses of botox, xeomin, or dysport act to paralyze and relax wrinkles more completely. Low dosages for the most part deliver a more relaxed appearance. When rejuvenating with hyaluronic acid fillers, such as juvederm, restylane, or voluma, superficial, intermediate, and deep layers maybe injected in the periorbital region. Filling and correction of tear trough deformities should take place in the deeper layers when they had been present since early life, and deeper when they had been acquired through, tissue descent, thinning of skin, and other age associated changes. Finally, the entire region should be evaluated completely and treated with as many modalities as necessary to effect the necessary change.
