Introduction  

Crow’s feet refers to fine lines (wrinkles) that form around the eyelid. The wrinkles pose no danger to vision but some individuals seek treatment for physical, emotional and social reasons. Improved physical appearance is important for their self-esteem.

Also Known As

  • Crow’s foot
  • Laugh lines
  • Wrinkles
     

Sub-Types

There are two main types of crow’s feet:

  • Dynamic lines which emanate from smiling, laughing, frowning and squinting. These wrinkles are found between the eyebrows, on the forehead, at the corner of the eyelids and around the lips. They are congenital, meaning everyone is born with them. As people grow old, the wrinkles sink deeper into the skin making them stand out. 
  • Static facial lines are actual visible lines present at all times even when one is asleep. They result from a long history of exposure to ultraviolet (UV) rays. UV rays and aging can lead to the thinning of collagen. Collagen is a protein that lies underneath and within the deep layers of the skin. Collagen thinning causes the face to stretch and sag giving rise to the wrinkles. 
     

Causes and Risk Factors

The following may cause crow’s feet:

  • Age - As one ages, the body produces less natural oils which dry the skin to result in wrinkles. 
  • Ultraviolet rays - UV light affects elastic fibers and collagen which make up the body’s connective tissue. UV radiation encourages natural aging which can lead to wrinkles. 
  • Repeated facial expressions - Frequent squinting, smiling and frowning can lead to wrinkles. With each use of a facial muscle, a groove forms under the skin's surface. Due to age, the skin is no longer flexible to spring back to position causing the groove to remain and form a wrinkle. 
  • Fat - Fat in the deeper area of the skin may diminish resulting in saggy and loose skin. 
  • Smoking - Changes in the blood supply occasioned by smoking can lead to wrinkles.

Signs & Symptoms

Signs of crow's feet include lines and creases on the skin. Some wrinkles look like deep furrows, especially around the mouth, neck and eyes.

Treatment 

Treatment is directed towards lessening or removing the wrinkles around the eye.

Medical Treatment

Topical creams like Tretinoin can help to keep wrinkles away The drug stimulates the growth of new skin. Anti-aging moisturizers may assist but may not improve deep crow's feet. 

Neuromodulators or botulin toxin can treat crow's feet by relaxing the wrinkles or lines. Botulin toxin includes drugs such as Botox, Xeomin and Dysport. The eye doctor injects it directly into the underlying muscles. Doctors do not recommend the medication for persons below 18, those with neuromuscular disease, pregnant women and those with dermatological problems near the injected area. People with weak facial muscles, ptosis, deep facial scars, uneven facial features and very thick facial skin should also not have the injection. 
Dermal fillers can aid in smoothing out the wrinkles caused by crow’s feet. They include hyaluronic acid gel, collagen injections and poly-L-lactic acid. 
A chemical peel improves the skin’s appearance on the hands, neck and face. The doctor applies a chemical solution which leads to exfoliation of the skin. The skin eventually peels off. The three types of chemical peel treatments include superficial, medium-depth and deep. Medium-depth and deep peel can aid in age spots, lines and wrinkles. The new skin that grows is less wrinkled and smoother than the previous skin.

Surgical Treatment

Laser resurfacing is a procedure that removes layers of skin to treat minor flaws on the face or improve the skin’s appearance. The two types include erbium laser which removes fairly deep lines and wrinkles on the chest, face, neck and hands. Carbon dioxide (CO2) treats warts, scars, wrinkles and other skin problems. 
Dermabrasion uses a diamond wheel containing rough edges or a wire brush to remove the upper layer of the skin. The procedure also levels the skin. When the treated area heals, new skin grows in its position.

Prognosis/Long-term outlook

The results depend on the treatment. Some individuals need to continuously use the treatment while others go for repeat treatment. For example, patients need Botox injections every three to four months. Some drugs have been shown to have no or limited effects on some people. For others, drugs may gradually smooth out the appearance of the underlying skin. With time, the wrinkles become less noticeable. 

Healing time depends on the method used. Dermabrasion takes weeks while it may take months to recover from a laser procedure. 
Side effects of crow’s feet treatment may include headache, redness in the injected area, red eyes, tearing and eye irritation. Others are skin discoloration, infection, pain, bumps, bruising and itching. Laser surgery side effects include scarring and a darkened skin color. 
Ptosis or drooping eyelids is a side effect of botulin toxin. It occurs when the layers of skin over the eyelids lose their elasticity and drop. The sagging skin may cause the eyelids to interfere with vision.

Prevention/Follow Up

The following can help in preventing wrinkles:

  • Avoid smoking.
  • Use in-built sunscreen products to block UV rays.
  • Eat a healthy diet. Vitamins can assist in protecting the skin. 
  • Use moisturizers. They do not prevent wrinkles but may hide creases temporarily. 
  • Protect oneself from ultraviolet rays. Individuals can wear protective items such as sunglasses, wide-brimmed hats, long-sleeved blouses, etc. Sunscreen can also help when going outdoors.