The Orbicularis Oculi Muscle · Anatomy and Treatment Logic
What you will find here: the anatomy of the circular eye muscle, the difference between smile lines and crow’s feet, individual dosing logic, complications with a focus on pseudo eye-bags and bruising, and combination options with a suborbital treatment. Booking and fee information on the treatment page.
Crow’s feet arise at the sphincter-like orbicularis oculi muscle — a ring-shaped muscle that surrounds the eye and produces the lateral lines when squinting. Anyone wanting to understand the treatment should recognise: not every eye line is a “crow’s-foot line.” The region is anatomically delicate — the risk of diffusion into neighbouring structures is higher than at the forehead or glabella.
The sphincter-like eye muscle
The orbicularis oculi muscle is anatomically unusual: it has no classic origin and insertion point like other muscles of facial expression, but runs in a sphincter-like circular path around the eye — like a closing muscle. Its fibre rings form three functional parts:
| Part | Location | Function |
|---|---|---|
| Pars orbitalis | Outer ring, at the bony orbital rim | Forced eye closure, “squinting” — produces the lateral crow’s feet |
| Pars palpebralis | Inner ring within the eyelid itself | Gentle eye closure, voluntary winking, blinking |
| Pars lacrimalis | Medial, at the lacrimal sac | Tear drainage via a pumping action during eye closure |
The part relevant for crow’s-feet treatment is primarily the pars orbitalis — and within it the lateral portion outside the orbital rim. The pars palpebralis is not treated, as it is responsible for normal eye closure; weakening it there would lead to incomplete eye closure and dry eye.
Anatomical dual role: eye closure and brow depressor
A special feature of the orbicularis oculi muscle is its dual function: while the whole muscle contributes to eye closure, the lateral portion of the pars orbitalis also acts as a brow depressor. Targeted weakening of this lateral portion — as in crow’s-feet treatment — therefore produces a slight lateral brow lift as a desired secondary effect. When an isolated brow lift is wanted, only the lateral orbicularis is treated specifically, without addressing the crow’s feet.
Smile lines, crow’s feet and skin folds — three different things
Patients often come with “the lines around the eye” — but mean different structures that must be assessed quite differently, anatomically and therapeutically:
| Type of structure | Anatomy | Treatment |
|---|---|---|
| Smile lines | Dynamic lines when laughing, from pars orbitalis activity. Completely normal in younger people. | Botulinum toxin works well, but the question is: does the patient want to remove them? They often look likeable. |
| Crow’s feet (classic) | Dynamic lines that remain visible at rest due to loss of elasticity — typical from age 30 onward. | Botulinum toxin is effective; the main indication of the region. |
| Static periorbital skin folds | Structural folds from collagen breakdown, actinic elastosis, sun exposure. Strongly visible even at rest. | Botulinum toxin reduces the dynamic component — for the static residual marking, fillers, skin resurfacing or other procedures are a useful addition. |
Children and adolescents already have smile lines that convey a friendly appearance. From the age of 30 onward, with increasing loss of skin elasticity, persistent and then often bothersome smile lines gradually develop. As elastosis increases, these lines come to resemble crow’s feet and are perceived as signs of ageing.— Wiest L et al., Faltenbehandlung mit Botulinumtoxin A · Springer textbook
The consultation therefore always begins with the question: What exactly should be treated — and why? Some patients only realise during the conversation that their smile lines are an element of charm they do not actually want to lose.
Why the periorbital region is dosed lower
Compared with the glabella and forehead, the periorbital dose is markedly lower — and this has two reasons: the orbicularis oculi is a thin, superficial muscle, and the region is anatomically delicate (eyeball, lacrimal drainage, diffusion toward the levator palpebrae muscle).
Basic injection pattern
Recommended are 3 to 4 (in exceptional cases 2–5) injection points in the lateral part of the orbicularis oculi muscle, about 1 cm outside the orbital rim, arranged in a crescent with 1–1.5 cm spacing. The needle tip points away from the eye in each case, and the injection is very superficial (subdermal) with minimal volumes (typically under 0.1 ml per point).
With far-reaching lining
With very strong muscles or lining that extends far laterally, a second lateral row of injections can be useful — the total dose is then distributed across the additional points. A combined treatment of the lateral cheek (mid-face) may also be indicated with a pronounced line topography, but this is a separate indication.
Factors in individual dose-finding
- Line depth and muscle strength. Both are palpated and assessed visually during voluntary squinting.
- Topography of the lines. Upper, middle or lower third — dose adjustment and point variation accordingly.
- Skin elasticity (snap test). Before every periorbital treatment — a delayed snap test indicates pre-damaged elasticity, which increases the risk of pseudo eye-bags.
- Pre-existing dark circles / lower-lid oedema. With a tendency to swelling, the lower portion is reduced or avoided.
- Prior eyelid surgery. After lower-lid surgery (blepharoplasty) the risk of ectropion is increased — dose cautiously.
Pseudo eye-bags and other undesired effects
Crow’s-feet treatment is among the well-established indications of the upper third of the face — complications are rare, but specific to the region. Open, honest counselling is an essential part of the consultation.
Pseudo eye-bags — the specific periorbital adverse effect
Pseudo eye-bags are not true under-eye bags (fat pads), but oedema of the lower-lid area due to impaired lymphatic drainage. The orbicularis oculi muscle normally pumps lymph toward the lacrimal punctum with every eye closure. When it is pharmacologically quieted, the lymph backs up — visible as a swelling under the eye.
Frequency: about 5 % of all periorbital treatments, somewhat more common in patients with a pre-existing tendency to lower-lid oedema or pronounced skin elastosis. Duration: 4–8 weeks, fully reversible.
Treatment strategies for pseudo eye-bags
- Gentle lymphatic drainage and connective-tissue massage in a lateral direction
- Sleeping with the head raised (30° position) reduces nocturnal accumulation
- Cooling in the morning (covered eye cold packs)
- Watchful waiting — the effect subsides as the toxin effect wears off
- With a pre-existing tendency to under-eye bags, a blepharoplasty would be the long-term structural solution — but never as a short-term reaction to pseudo eye-bags
Other undesired effects
| Observation | Frequency | Duration |
|---|---|---|
| Bruising at injection sites | common — the periorbital region is very vascular | 5–10 days |
| Pseudo eye-bags (oedema) | occasional (approx. 5 %) | 4–8 weeks |
| Asymmetries between right and left | occasional at the first appointment | until touch-up, then resolved |
| Impaired eye closure (“dry eye”) | rare | 2–6 weeks, artificial tears helpful |
| Diplopia (double vision) | very rare — with injection that is too deep and paralysis of a rectus muscle | 4–8 weeks |
| After lower-lid surgery: increased risk of ectropion | rare | 4–8 weeks |
Bruising — purely a question of technique
The periorbital region is the most vascular area of the upper face. Despite the finest needles, bruising is more common than at the forehead or glabella. Avoidance strategy: no acetylsalicylic acid or vitamin-K antagonists in the 5 days before treatment, a cold pack before the injection, and precise needle guidance away from visible small vessels. Bruises disappear completely within 5–10 days.
“Open eye” — the suborbital extension
A less frequently performed but, for some patients, very valuable extension of crow’s-feet treatment is the co-treatment of the caudal portion of the orbicularis oculi muscle — just below the lower lid. The aesthetic goal is a widening and rounding of the eye (the “open eye” effect) by weakening the lower portion of the closing muscle.
Important particulars
- The safety distance of 1 cm from the orbital rim that otherwise applies is undercut here — typically 1 cm below the lid margin itself.
- Very low dose: 2 U on average (0.5–4 U) per side, at 1–2 points.
- Recommended only in younger patients with an unremarkable snap test (good lid elasticity).
- Not all experts perform this extension — it is associated with a higher risk of pseudo eye-bags, impaired eye closure and dry eye.
When it makes sense, when it does not
Sensible in younger patients with dynamic periorbital line activity that extends into the lateral cheek — here the suborbital extension produces an overall improvement.
Not sensible with pre-existing lower-lid oedema, reduced skin elasticity, prior lower-lid surgery, or in patients with a “heavy bag” constitution (true under-eye bags / fat pads) — here the effect would be minimal and the likelihood of pseudo eye-bags high.
What crow’s-feet treatment is not
Four precise distinctions
- It is not a filler. Deep, static skin folds of the eye region are structurally altered (collagen breakdown, actinic elastosis). Botulinum toxin reduces the dynamic line — for the static residual marking, a hyaluronic acid filler or a skin-resurfacing procedure can be a useful addition. The 2007 consensus recommendations describe the combination of botulinum toxin + filler for deep lines as “almost mandatory.”
- It is not “removing the under-eye bags.” True under-eye bags are fat pads that herniate forward through a connective-tissue septum — they are a surgical matter (blepharoplasty). Botulinum toxin cannot reduce them. A periorbital treatment would not correct true under-eye bags.
- It does not remove dark circles. Dark circles arise from pigmentation, thin skin over venous structures, or an anatomical tear-trough deformity. Botulinum toxin has no effect on them. Specific procedures for this: pigment lasers, skin-regeneration therapies, targeted tear-trough filler.
- It is not suitable for everyone. Patients with pre-existing lower-lid oedema, pronounced skin elastosis, a poor snap test, or a history of lower-lid surgery are a relative contraindication. The periorbital decision is made after the medical history, snap test and expression analysis — not according to a desired image.
What patients want to understand more deeply
Will my eyes look “frozen” after the treatment?
Not with correct dosing. The lateral crow’s feet are reduced while the central eye expression (eye closure, winking, laughing) is preserved. A “frozen” eye expression only arises with clear overdosing — which is rare at the low periorbital doses (9–12 U per side). Anyone who wants to pause expression entirely signals this during the consultation — but it is not a common request.
How many injection points are placed?
Classically 3–4 points per side, in a crescent shape 1 cm from the orbital rim, with 1–1.5 cm spacing. With more extensive lining there may be 5 points, sometimes combined with a second row laterally. The exact number follows from the expression analysis, not from a fixed rule.
Can I combine crow’s-feet treatment with the glabella + forehead?
Very often sensible — the three regions together form the upper third of the face and are frequently treated as an “upper face” bundle in aesthetic medicine. The total dose is then around 35–50 U. Advantage: a harmonious overall result, a single treatment appointment, and a shared follow-up after 14 days. The fee arrangement is discussed transparently during the consultation.
What exactly are pseudo eye-bags — and how do they differ from true under-eye bags?
Pseudo eye-bags are temporary lymphatic oedema of the lower lid that arises from the pharmacologically paused pumping function of the orbicularis oculi muscle. They disappear completely once the toxin effect subsides. True under-eye bags, by contrast, are fat pads that protrude forward through a weakened connective-tissue septum — they are anatomically permanent and treatable only surgically (blepharoplasty).
Will I get dry eyes after the treatment?
Rarely — and if so, temporarily for 2–6 weeks. With correct dosing, only the lateral pars orbitalis portion is weakened, not the pars palpebralis (inner lid region) — so eye closure and tear production remain normal. If temporary dry eyes occur: artificial tears help without difficulty.
When does a filler combination make sense?
With deep, static periorbital skin folds that remain as a residual marking even after the toxin takes effect. The 2007 consensus recommendations describe the combination of both procedures for deep lines as “almost mandatory.” The filler is typically added 14 days after the botulinum toxin treatment, once the toxin effect can be assessed.
What happens with prior eyelid surgery?
After lower-lid surgery (blepharoplasty), the risk of ectropion (the lower lid tipping outward) is increased — weakening the orbicularis oculi muscle can further destabilise the lid. In these cases the suborbital component is strictly avoided and the lateral periorbital dose is also reduced. A prior ophthalmological assessment is recommended in case of doubt.
Does the treatment affect my vision?
With correct technique, no. Diplopia (double vision) from paralysis of an eye muscle (a rectus muscle) is the most serious but very rare complication of periorbital treatment — it arises exclusively from injection that is too deep or diffusion through the orbital septum. Avoidance strategy: a superficial injection technique with the needle tip pointing away from the eye. In the rare case of diplopia, it subsides completely over 4–8 weeks.
The scientific basis for the treatment
Consensus recommendations Sommer/Bergfeld/Sattler, 2007 — German-language consensus
Konsensusempfehlungen zum Gebrauch von Botulinumtoxin A in der ästhetischen Medizin. JDDG Supplement 1, Band 5. Describes for the periorbital region: the orbicularis oculi pars orbitalis as the target muscle, dosing ranges of 9–10 U (women) / 12 U (men) per side, 3–4 injection points in a crescent, a safety distance of 1 cm from the orbital rim, and pseudo eye-bags and bruising as specific adverse effects. Most of the practical statements on this page draw on this consensus.
Carruthers JD & Carruthers JA — periorbital indications
The Carruthers (a physician couple) not only gave the first description of the glabellar indication, but also described the periorbital application systematically at an early stage. Crow’s-feet treatment is among the longest-established aesthetic botulinum toxin indications and is very well documented by clinical studies.
Wiest L et al. — textbook on practical implementation
Faltenbehandlung mit Botulinumtoxin A und besondere Indikationen. Springer-Lehrbuch. Describes the periorbital region in detail, with injection techniques, the differentiation of smile lines vs. crow’s feet, microinjection technique (intradermal microdepots) and complication management. The description of the suborbital extension with the snap test is particularly thorough here.
Periorbital dose-finding study
A specific dose-finding study for the periorbital region arrives at a somewhat higher base dose of 12 U per side — this is referenced in the 2007 consensus recommendation. The individual adjustment of the dose to the line and muscle situation is described in both sources as more important than a fixed pattern.
This selection represents the essential sources — it is not exhaustive. Crow’s-feet treatment is among the oldest and best-documented aesthetic indications. The works cited here form the methodological framework for everyday clinical decisions.
Would you like to discuss the treatment in person?
The treatment page with the treatment process, duration of effect and fee information is here:
Crow’s feet · Treatment overviewFor an overview of all wrinkle treatments with botulinum toxin, see the category page.
For patients from the Erlangen area: botulinum toxin in the Erlangen area.
Dr. med. Thomas Ackermann
Specialist in Anaesthesiology · Medical Director, Harmonie der Ästhetik
The periorbital region is anatomically delicate — directly over the eyeball, at the edge of the tear drainage, with rich vascularity and diffusion risks. The background in anaesthesiology shapes the methodical handling of agent control in such regions — precise dosing, superficial technique, clear counselling. This page was last reviewed on 17 May 2026.
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