Crow's feet

Crow’s feet are the fan-shaped lines that appear at the outer corners of the eyes and become most visible when smiling or squinting. They are one of the first visible signs of facial ageing and one of the most common expression lines.

Why they appear

They are caused by the repeated contraction of the orbicularis oculi, the circular muscle around the eye that allows us to close the eyes, blink and smile. Each contraction creases the skin above it, which in this area is very thin and has little fat underneath.

Over the years the skin loses collagen, elastin and hydration, and stops bouncing back when the muscle relaxes. Besides age, other factors play a role:

• Sun exposure (photoageing), the most important external factor.
• Smoking, which reduces collagen production.
• Genetics and skin type: thin, fair skin tends to wrinkle earlier.
• Expressiveness: smiling a lot or squinting often (for example, by not wearing sunglasses or not correcting a vision problem).

Types

• Dynamic: only visible with facial movement. They appear first and disappear when the face is at rest.
• Static: still visible with the face relaxed, because the skin has lost elasticity and the line has become etched.

Telling them apart matters, because they are treated differently.

Treatment

• Botulinum toxin (Botox): the first-line treatment for dynamic crow’s feet. Small doses are injected into the outer part of the orbicularis muscle to relax it without removing expression. The effect appears within a few days and lasts several months. Its efficacy and safety in this area are well studied.
• Hyaluronic acid: for static, etched lines a very fine hyaluronic acid can soften the crease, usually combined with botulinum toxin.
• Skinbooster and chemical peels: improve the quality, hydration and texture of the skin around the eyes, useful for fine lines and dull skin.

If crow’s feet come with excess eyelid skin or bags, the problem is not only muscular and blepharoplasty may be considered.

Prevention

• Daily sun protection and sunglasses.
• Not smoking.
• Moisturising the eye area and, if a doctor recommends it, using topical retinoids.
• Low-dose botulinum toxin in young people with strong muscles (so-called preventive Botox) can delay lines from becoming etched.