Botox Use in the Lower Lid

At low doses of 2 U per eyelid, botulinum toxin A (Botox) has been shown to diminish infraorbital wrinkles and widen the eye; the effect is enhanced with lateral orbital injections. If a little is good, would more be better? In this randomized study, 11 patients received 4 U of Botox into each lower eyelid and 12 U into one lateral orbital area; another 8 patients received 8 U into each lower eyelid and 12 U into one lateral orbital area. The lower-lid doses were divided in half and injected 3 mm below the lash line at two sites: the midpupillary line and halfway between the midpupillary line and the lateral canthus. Patients with a history of lower-lid surgery, laser resurfacing, dry eyes (abnormal Schirmer's test), ectropion, or weak snap…