By LIV Clinic · Medically reviewed by Dr. Narathai Vichienkalayarut, M.D. · Published October 16, 2026

Under the eye, the two treatments answer completely different questions — and sometimes the right answer is neither.

Botox or filler for under eye wrinkles? It depends on what is causing them. Botox treats lines driven by muscle movement — crow’s feet and crinkling when you smile. Filler treats lines caused by volume loss and hollowing in the tear trough. Crepey skin texture under the eye responds to neither and needs a skin treatment instead.

Three different under-eye problems

Movement lines

Crow’s feet and the crinkling that fans out when you smile are dynamic — caused by the orbicularis muscle encircling the eye. These are what botulinum toxin addresses.

Volume loss

A tear-trough hollow casts a shadow and is a structural problem. The Cleveland Clinic describes dermal fillers as adding volume to areas that have lost it, which is why filler, not toxin, is the tool here.

Skin quality

Thin, crepey, finely lined skin with no hollow and no movement component is a texture problem. Neither injectable improves it meaningfully.

What Botox can and cannot do under the eye

Where it works

At the outer corner, softening the muscle reduces smile crinkling. The American Academy of Ophthalmology explains that botulinum toxin blocks the nerve signals that make muscles contract, which is exactly the mechanism needed for dynamic lines.

Where it is risky

Directly beneath the eye the muscle also supports the lower lid. Over-treating there can worsen puffiness or affect lid function, so dosing immediately under the eye is conservative or avoided entirely.

What filler can and cannot do under the eye

Where it works

A shallow hyaluronic acid placement can soften a genuine tear-trough hollow and reduce the shadow that reads as a dark circle.

Where it goes wrong

The under-eye is one of the least forgiving areas in aesthetics. Over-filling, placing product too superficially or treating fluid-retentive skin can produce lasting puffiness or a bluish tinge. Hyaluronic acid filler can be dissolved, which is a real advantage here.

Side-by-side comparison

Durations are typical ranges, not promises; individual results vary.

How to tell which problem you have

A simple self-check before your consultation:

• Lines only visible when you smile — dynamic, Botox territory
• A shadow under the eye that looks worse when tired — likely volume or hollowing
• A hollow you can feel as a groove with a fingertip — structural, filler territory
• Fine crinkled texture with no hollow and no movement — skin treatment territory
• Puffiness that changes through the day — often fluid, and a reason to avoid filler

When the answer is neither

Pigmentation and fluid

Dark circles caused by pigmentation or by fluid retention do not improve with either injectable, and filler can make fluid-related puffiness worse.

Significant lower-lid laxity

Where loose lower-lid skin is the dominant issue, injectables add little. A device-based skin treatment or a surgical opinion is the honest recommendation.

Step-by-step: deciding and preparing

How to approach this safely:

1. Photograph your under-eye area at rest and smiling, in natural daylight.
2. Note whether the appearance changes through the day, which points to fluid rather than volume.
3. Book a consultation specifically for under-eye assessment rather than booking a treatment.
4. Ask which of the three problems — movement, volume or texture — your doctor sees.
5. If filler is recommended, confirm a reversible hyaluronic acid product is being used.
6. Avoid alcohol and blood-thinning supplements for 24–48 hours beforehand, where appropriate.
7. Review at two weeks before adding anything further.

Under-eye assessment at LIV Clinic

Diagnosis first

Because the under-eye rewards restraint, Dr. Narathai assesses which of the three problems is actually present before any product is discussed — and will say so if neither injectable is the right answer.

Explore the options

See our Botox and wrinkle treatments and dermal filler pages, or book a consultation on Koh Samui or Koh Phangan.

Frequently asked questions

Safety and consultation

Under-eye injectable treatment is a prescription medical treatment and, like any injectable, carries some risk — common temporary effects can include redness, swelling, bruising, mild headache or a short-lived heaviness, and less common reactions such as temporary eyelid or brow droop are possible. Results vary from person to person, and no specific outcome can be promised. This article is general information, not medical advice.

At LIV Clinic, every treatment begins with an in-person assessment by Dr. Narathai Vichienkalayarut, M.D., who reviews your skin, medical history and goals before recommending a personalized plan. Book a consultation to find out whether this treatment suits you.