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Is the use of botulinum toxin (“Botox”) safe and efficacious for the treatment of Crow’s feet lines and wrinkles?

Dr V Swaminathan. Clinic Aesthetics (Clinic@), Harley Street, London, W1G 9PF

24th February 2021

Botulinum toxin, also known as “Botox”, is currently used extensively in clinical practice for various medical and aesthetic indications, including for the improvement of facial lines and wrinkles. There were more than 6.6 million procedures reported in 2014 (1). A common area for treatment is the lateral canthal wrinkles or crow’s feet lines (2). These wrinkles are related to a person’s smiling expression and can be one of the earliest signs of the ageing process on the face (3).

Injections of “Botox” in this area causes reduction in muscle contraction, which helps to improve the appearance of lines and wrinkles around the eye. Specific brands of Botulinum toxin (“Botox”) are approved for use in the treatment of Crow’s feet lines in more than 50 countries (4), but is this procedure safe and effective?

When looking at the published literature related to the safety and efficacy of “Botox” use for the treatment of Crow’s feet lines, the general consensus is that Botulinum toxin (“Botox”) treatment for crow’s feet lines is efficacious. Studies have demonstrated that Botulinum toxin is safe and effective in decreasing the severity of crow’s feet lines, with patients reporting a 50% or greater improvement in the appearance of their crow’s feet lines following treatment (5). In addition, patients who had “Botox” treatment rated themselves as looking younger than their current age (6).

The safety of “Botox” for crow’s feet lines was found to be consistent with other facial treatment areas, such as the frown area, with no evidence of spread or new safety concerns identified even after multiple treatment cycles (6). Botulinum toxin is well tolerated, with the most common side effects related to local treatment effects, such as injection site bruising or pain (5-8). Therefore, we can conclude that “Botox” is both a safe treatment and efficacious for the management of Crow’s feet lines.



  1. Surgeons ASoP. American Society of Plastic Surgeons Reports 15.1 Million Cosmetic Procedures in 2013; Marks Fourth Consecutive Year of Growth 2014 [Available from:
  2. Carruthers A, Carruthers J. Botulinum toxin type A: history and current cosmetic use in the upper face. Semin Cutan Med Surg. 2001;20(2):71-84.
  3. Baumann L, Slezinger A, Vujevich J, Halem M, Bryde J, Black L, et al. A double-blinded, randomized, placebo-controlled pilot study of the safety and efficacy of Myobloc (botulinum toxin type B)-purified neurotoxin complex for the treatment of crow’s feet: a double-blinded, placebo-controlled trial. Dermatol Surg. 2003;29(5):508-15.
  4. Harii K, Kawashima M, Furuyama N, Lei X, Hopfinger R, Lee E. OnabotulinumtoxinA (Botox) in the Treatment of Crow’s Feet Lines in Japanese Subjects. Aesthetic Plast Surg. 2017;41(5):1186-97.
  5. Lowe NJ, Ascher B, Heckmann M, Kumar C, Fraczek S, Eadie N, et al. Double-blind, randomized, placebo-controlled, dose-response study of the safety and efficacy of botulinum toxin type A in subjects with crow’s feet. Dermatol Surg. 2005;31(3):257-62.
  6. Carruthers J, Rivkin A, Donofrio L, Bertucci V, Somogyi C, Lei X, et al. A Multicenter, Randomized, Double-Blind, Placebo-Controlled Study to Evaluate the Efficacy and Safety of Repeated OnabotulinumtoxinA Treatments in Subjects With Crow’s Feet Lines and Glabellar Lines. Dermatol Surg. 2015;41(6):702-11.
  7. Carruthers A, Bruce S, de Coninck A, Connolly S, Cox SE, Davis PG, et al. Efficacy and safety of onabotulinumtoxinA for the treatment of crows feet lines: a multicenter, randomized, controlled trial. Dermatol Surg. 2014;40(11):1181-90.
  8. Ascher B, Rzany BJ, Grover R. Efficacy and safety of botulinum toxin type A in the treatment of lateral crow’s feet: double-blind, placebo-controlled, dose-ranging study. Dermatol Surg. 2009;35(10):1478-86.