What are the contraindications for botulinum toxin treatment of lower eyelid wrinkles?

Contraindications for botulinum toxin treatment of lower eyelid wrinkles include skin laxity, infraorbital festoons (eye bags), excessive scleral show, and lagophthalmos. These conditions can worsen with treatment, making botulinum toxin unsuitable for these patients.

Botulinum toxin treatment for lower eyelid wrinkles is contraindicated in patients with certain conditions that can be exacerbated by the procedure. Skin laxity in the lower eyelid can lead to increased wrinkles if treated with botulinum toxin, and surgery is often required instead. Infraorbital festoons, or eye bags, can worsen due to the weakening of the orbicularis oculi muscle. Excessive scleral show, where more than 2 mm of sclera is visible, indicates lower lid retraction and is a contraindication. Additionally, lagophthalmos, which is the incomplete closure of the eyelids, is also a contraindication as it can be exacerbated by the treatment.