In short. Why no rung removes the lines, what maintenance actually asks of you, where surgery sits and why it is rarely the answer, and when keeping the lines is reasonable.
Key points
- The crease softens and the muscle keeps working.
- Nothing on the ladder removes a line established in skin that has lost its support, and nothing stops the fold forming again the next time you laugh.
- What is traded is a softer line in ordinary light, in exchange for appointments, consistency and the trade-offs at the lid.
The ladder has a top, and it is lower than most advertising suggests. Every rung below it softens the lines. None of them removes them, and the reason is not a limitation of technique that better equipment will solve.
Why nothing erases them
There are two mechanisms and neither can be reversed. The fold is made by the orbicularis oculi, which cannot be switched off without affecting the lid and the tear film, so it keeps folding the skin for as long as you smile. The rest of the line is a dermis that has lost collagen and elastin in the thinnest skin on the face, and lost dermis is not rebuilt by anything on the ladder. Softening is available. Erasure is not.
What maintenance actually means
The muscle rung fades over months as the nerve endings recover, so it is repeated rather than completed. The skin rung is not a course at all: protection and a routine the lid tolerates have to be kept up or the benefit stops. Maintenance is not a phase that follows treatment. It is what treatment is.
The ceiling, stated plainly
The crease softens and the muscle keeps working. Nothing on the ladder removes a line established in skin that has lost its support, and nothing stops the fold forming again the next time you laugh. What is traded is a softer line in ordinary light, in exchange for appointments, consistency and the trade-offs at the lid.
Where surgery sits
The top of the ladder is a temporal or midface lift, and it addresses descent rather than lines. It does not remove the orbicularis oculi, so the muscle continues to fold whatever skin lies over it, and a face whose problem is folds rather than sagging has little to gain from it. Where an operation is the right way to change the upper face, that is a decision about the brow and the face rather than about crow's feet.
When keeping the lines is reasonable
A face with faint lines and normal movement usually looks better than one with no lines and no movement. These lines are the ordinary mark of decades of laughing, squinting and being out in the light, and many people who ask about them decide after an examination to keep them. That is a finding rather than a failure to be talked out of.
Three things not to accept
- A plan that offers an eye corner with no lines at all, which no rung of the ladder produces.
- A muscle treatment given without anyone recording lid closure, the tear film and the brow position first.
- A schedule of appointments set years ahead, rather than a decision made each time the movement returns.
Judge a result against a photograph taken at rest before the first treatment, in ordinary light rather than under a lamp from above. The rungs below this ceiling are set out in the conservative rungs for crow's feet and in resurfacing crepey eye-corner skin.
Frequently asked questions
If nothing removes them, what is the point of treating at all?
The point is a softer line in ordinary light, and for many people that is worth having. The muscle rung flattens the crease in movement and lets the skin recover between movements; the skin rungs change texture and tone. What none of them does is produce an eye corner without lines, and a person who wants that is not going to be satisfied by anything on the ladder. Knowing the difference is most of the decision.
How do I judge whether a result is good enough to carry on?
Against a photograph taken at rest before the first treatment, in ordinary light rather than under a lamp from above, and against your own earlier face rather than a face in an advertisement. A result in which the line is less obvious when you are not smiling and the eye still closes comfortably is a good result. A result judged only on a smiling photograph in a clinic mirrors the expectation that was set there rather than the one you arrived with.
Is it a failure to decide the lines are fine as they are?
It is a finding, and a common one. The lines are the ordinary mark of decades of laughing, squinting and being out in the light, and many people who ask about them decide after an examination to keep them. A clinician who treats that answer as a disappointment is describing their own preference rather than your face, and it is a reasonable thing to say out loud in the room.
Risks & Limitations
- Nothing erases crow's feet. The lines soften with treatment and return as the orbicularis oculi keeps folding the skin.
- Reducing the pull of the muscle at the eye corner can affect lid closure, the tear film and the position of the brow.
- Material placed near the eye corner can show through thin skin, and this is one of the least forgiving areas of the face.
- Resurfacing thin periorbital skin carries a risk of pigment change, redness that persists and, rarely, scarring.
- Treatment in this area is repeated rather than completed, and the decision is remade each time the movement returns.
When to Seek Care
- Difficulty breathing or chest pain — seek emergency care immediately.
- A change in vision, double vision, or pain on moving the eye after treatment to this area.
- An eye that has become dry, gritty or painful, with a lid that no longer closes comfortably.
- Lines that have appeared on one side only, a lid that has begun to droop, or a brow that has fallen.
- A new lump or swelling at the corner of the eye, or a patch of skin that bleeds, crusts or does not heal.
References & Further Reading
- American Society of Plastic Surgeons (ASPS) — procedure and safety guidance
- National Institute for Health and Care Excellence (NICE, UK) — relevant guidance
- Cochrane Library — systematic reviews
- Chinese Medical Association Plastic Surgery Branch — clinical guidance
This page is patient education, not medical advice, and it does not cite individual studies. Discuss your own case with a qualified clinician. To arrange an assessment at Chongqing West District Hospital, see Contact & Consultation.