Crows Feet

In general, patients with fair skin and blond or red hair show the effects of aging at an earlier stage. Blue or green eyes are more sensitive to daylight and as a consequence, squinting in bright sunlight may mechanically contribute to the lateral periorbital skin wrinkles. Patients with darker complexions have more protection, especially if their skin is more sebaceous. Eyelid skin wrinkling may also result from ultraviolet

Table 5.4. Characteristics of the m. orbicularis oculi

Muscle

Action

Synergists

Antagonists

M. orbicularis oculi

Orbital part: protrusion of the eyebrows and voluntary eyelid closure Palpebral part: closes lids during blinking Lacrimal part: draws lids and lacrimal papillae medially, compresses the lacrimal sac

M. corrugator supercilii and m. procerus

M. levator palpebrae superioris: for closing the eyelids

M. occipitofrontalis: protrusion of the eyebrows

ray damage, the desiccating effect of wind and from smoking.

Patients with thinner skin present very delicate wrinkling and patients with thicker skin present more prominent and deeper wrinkles. The more atrophic the skin is, the greater the quantity of fine wrinkles that may be found. Wrinkle extension also varies according to the 5 muscle size, and some wrinkles can go down to the cheek area.

Eyebrow ptosis may contribute to upper eyelid skin excess and skin wrinkling. The lower eyelid may present with eye bags. Eye bags may result from the laxity of the orbicularis oculi and are considered to be a pseudo-herniation. It is not advisable to inject botulinum toxin for the treatment of crow's feet in patients with prominent eye-bags. If the muscle gets more relaxed, the eye-bags may get worse and a more tired look may result.

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