Definition
Crow’s feet or also called laugh lines, describe small, unpleasant, star-shaped wrinkles at the outer corner of the eye. Because of their radiant appearance, they resemble the feet of crows. Crow’s feet are usually the most pronounced form of laugh lines.
They form during various movements like blinking or laughing. With increasing age, the skin loses its elasticity and resilience. The result is that wrinkles can no longer recede properly, resulting in permanent, annoying wrinkles such as crow’s feet.
As described above, crow’s feet are caused by the strain on the ring-shaped eye muscle (M. Orbicularis oculi). This muscle is stressed by almost all facial movements (facial expressions), such as laughing or squeezing the eyes together. Since the skin is particularly thin at the outer corner of the eye, permanent stress there can lead to the formation of wrinkles particularly quickly.
The main cause of crow’s feet, however, as with all other wrinkles, is the dwindling content of hyaluronic acid in our tissue. From a biochemical point of view, hyaluronic acid is a long chain of sugar molecules which has the property of binding vast amounts of water molecules to itself. Thus, hyaluronic acid serves our skin as a huge water reservoir that provides stability and moisture.
In addition to hyaluronic acid, collagen and elastic fibers also provide elasticity and resilience. These help young skin to retract without any problems. From the age of 30 onwards, however, the content of hyaluronic acid, collagen and elastic fibers decreases continuously.
The result is that wrinkles can no longer retract and thus remain permanent. Crow’s feet have developed. In addition to the lack of hyaluronic acid, genetic factors, too much sunlight without adequate sun protection, smoking and an unhealthy lifestyle also play an important role in the development of wrinkles.
Treatment
If crow’s feet are perceived as very annoying, there are various ways to fight the unpleasant wrinkles. Popular ways of doing this are the injection of hyaluronic acid and botulinum toxin (also called Botox). Hyaluronic acid causes a firm, plump and youthful looking skin due to its moisture-binding and moisturizing properties.
Today it can be produced artificially in the laboratory and is very similar to the body’s natural hyaluronic acid. Hyaluronic acid can also be used as an alternative to injections as a gel, in creams (anti-aging) or in the form of capsules. However, since the skin can only absorb a small amount of hyaluronic acid, the effect is less pronounced and less effective than an injection where the hyaluronic acid is injected under the skin.
When injecting crow’s feet, hyaluronic acid is injected directly into the deeper layers of the skin using a micro-injection. This refreshes the body’s own hyaluronic acid depots there and mobilizes new fluid under the wrinkles. This results in an optical lifting and smoothing of the wrinkle.
The advantage of this treatment is the immediately visible effect and the few complications, e.g. bruises (haematoma) or slight swelling. Wrinkle smoothing lasts for 3 to 6 months and can be intensified and prolonged by the combination with botulinum toxin (Botox). This allows even very pronounced wrinkles to be removed.
Botox blocks the activity of muscle cells due to its neurotoxic effect. This leads to a desired relaxation (hypomimia) of the face, which prevents the formation of new wrinkles. Subsequently, hyaluronic acid is used to fill and smooth out the existing wrinkles in depth.
The combination of both together leads to an immediately visible wrinkle-free appearance and an even longer lasting effect. After 6 months a new injection would be necessary. However, hyaluronic acid can not only be used to fight wrinkles.
Nowadays, it is also used to spray on lips, nose, buttocks or breasts; in some cases even to model nipples. An alternative or combination of hyaluronic acid and botulinum toxin, Botox for short, already mentioned above, is also available. Botox is originally a nerve toxin, which is nowadays used in many ways in cosmetic medicine.
Its main areas of application include wrinkle reduction and the prevention of excessive sweating.As a nerve toxin, Botox prevents the transmission of excitation between nerve cell and muscle. This in turn causes the muscle to lose its signal for tension (contraction). As a result, the ring-shaped eye muscle (M. orbicularis occuli) no longer tenses when looking at the sun and there is no natural wrinkle formation.
The skin remains smooth and relaxed. Similar to hyaluronic acid injections, Botox treatment involves injecting the drug into the nerve endings of the desired muscle using a very small and fine needle. It is particularly important to have this application performed by an experienced and well-trained physician, as otherwise unloved complications such as asymmetries, a drooping upper limb or a drooping eyebrow are possible.
Instead, the effect of large, awake appearing eyes can be created by correct handling. An application with Botox lasts for 3-6 months on average, but it always depends on the amount of the applied dose and the treatment area. This means that the more nerve endings are treated with botulinum toxin, the longer the nerve endings need to regenerate and the longer the desired wrinkle-free effect.
However, even in the case of very deep crow’s feet, excessive doses of Botox should be avoided, as this can have considerable aesthetic disadvantages such as a “mask face” without mimic movements. Possible complications of a Botox treatment can – if used incorrectly – include drooping eyelids or eyebrows, impaired eyelid closure, swelling, redness or hematomas. Since the facial muscles must first be deactivated during Botox treatment, optical improvements are only visible after 48-72 hours.
After 10 days the maximum treatment success is visible. One surgical option for the long-term removal of crow’s feet would be the so-called face-lift, in which excess skin is removed and the underlying connective tissue is lifted using various techniques. The result is a firmer, younger-looking appearance.
However, as with all other operations, face-lifts can also cause complications such as bleeding and scarring, so this type of wrinkle treatment is more recommended for women of advanced age. Suitable procedures for crow’s feet include an upper face lift, which tightens around the forehead, eyebrows and temples, or a temple lift, which mainly tightens around the temples and eyebrows. However, very deep crow’s feet cannot always be removed by surgery alone.
For this reason, a combination therapy of surgery and hyaluronic acid or Botox is recommended. Complications have become very rare due to modern surgical and anaesthetic methods, but can still occur. Typical complications would be circulatory disorders, wound healing disorders, bleeding and nerve injuries, which would have serious consequences, especially on the face. Every single possible complication is discussed in detail in a medical consultation.