Beyond Wrinkles: Advanced Botulinum Injections around the Eyes to Improve Surgery

John R. Burroughs, M.D.
Cosmetic Oculofacial Plastic Surgeon
Medical Director, Springs Aesthetics
Colorado Springs, CO


This beautiful lady wanted to make her eyes more even and less wrinkled. She competes in beauty pageants and prefers to enter the competitions feeling confidently beautiful about every aspect of her appearance.  The right eye (left in picture) was smaller.  By injecting very tiny amounts of botulinum toxin to the right upper eyelid at the outer and inner portions near the lashes relaxes the orbicularis eyelid muscle in a manner that helps the eye open more as seen in the bottom photo.  The lower eyelid wrinkles were also improved nicely using small but very targeted doses of botulinum.  Other adjustments can be done for asymmetry of the brow positions that was also seen in this patient.

The above pre-injection shows the injection locations to help raise the eyelid margin.  Dr. John Burroughs has over 20 years experience using wrinkle blockers (Botox, Xeomin, Newtox, Dysport).  Injections directly near the eyelid margin are higher risk for bruising and ptosis.  Dr. Burroughs and some other respected colleagues published on injecting in this “pretarsal” orbicularis area for spasm patients with pseudo-apraxia of eyelid opening (“stuck together”) eyelids.  When receiving injections near the eyes its essential to know your injector understands the anatomy around the eyes.  This makes Dr. Burroughs a recognized expert on injecting around the eyes both with wrinkle blockers and fillers.  He has given international lectures on his surgical and minimally invasive periocular eyelid rejuvenation.  He has treated patients from coast to coast, and even from outside the United States.


Safety of Pretarsal Botulinum Toxin for Blepharospasm Associated Pseudo-apraxia: Is Ptosis a Real Concern?
James B Hsueh1, 2, John R Burroughs1 (john at drjohnburroughs dot com) #, Charles NS Soparkar3, John D McCann4
1 John R Burroughs M.D., P.C., 111 E Polk Street, Colorado Springs, CO, USA. 2 Midwestern University Physician Assistant Program, Glendale, AZ, USA. 3 Plastic Eye Surgery Associates, PLLC; Departments of Plastic Surgery/Head & Neck Surgery, M.D. Anderson Cancer Center; Department of Ophthalmology, Baylor College of Medicine; Department of Ophthalmology, Weill-Cornell Medical College, Houston, Texas, USA. 4 The Center for Facial Appearances, Sandy, UT, USA