Often time’s patients come to me for eyelid surgery (blepharoplasty) with desires which cannot be addressed by surgery alone. One of these desires is the reduction of wrinkles. The surgical part can remove excess skin muscle and fat. However, wrinkles will stay. The only way to consistently remove wrinkles is to do something to the skin (laser, peel, etc.) or weaken the muscle under the skin with Botox. Fillers like Restylane or Juvederm help in filling hollows more than in reducing wrinkles around the eyes.
There is a misconception that blepharoplasty surgery removes wrinkles. It generally does not. It does remove skin and all the wrinkles that are present in the excised skin. However, whatever skin is left will still be wrinkled. The take home message is that blepharoplasty surgery removes excess tissue only. Botox, on the other hand, does reduce wrinkles, especially what we refer to as dynamic wrinkles (those that are present with facial movement like smile). There is risk with injecting Botox to the eyelids themselves to reduce wrinkles, but in an experienced eyelid specialists hands, it can be done successfully.
In the example below, the patient had upper and lower blepharoplasty surgery, with postoperative Botox treatment to the lower lids. You can see the vast improvement in appearance after surgery (left before surgery/right after surgery). This shows how the combination of blepharoplasty surgery and Botox injections act synergistically (better together than each individually).