Botox Treatment - How Knowing the Interrelationship of Facial Muscles Helps Prevent Unwanted Results

Author: Amiya Prasad, M.D.

Thank you for your question! You submitted a question without any supporting photo so I’m just going to conjecture as to the locations based on your description which you state in your question that you had Botox™ injected high in the cheek area for smile lines and now you’ve developed some long deeper lines. And around the area you’re asking what could’ve happened. Well, I can certainly give you some ideas of what could be the possible issues based on your description. A little background, I’m a board certified cosmetic surgeon and fellowship trained oculofacial plastic and reconstructive surgeon. I’ve been in practice in Manhattan and Long Island for over 20 years and my specialty is oculofacial plastic surgery. Our group was the first to start using Botox™ when it was first FDA approved because of the indication for muscle spasm in the face, diseases or conditions such as benign essential blepharospasm and hemifacial spasm so I have lots of experience using Botox™. So in your description, you say it was placed in the high cheek area for smile lines.

It makes me think of maybe be crow’s feet is what you mean and crow’s feet are basically the result of muscle activity from the muscle called orbicularis oculi muscle. Now if the injections were done a little bit lower at the cheekbone level, then you may have also gotten some of the material injected into a muscle called the zygomaticus muscle or adjacent muscles. Now, yes when Botox™ relaxes a muscle depending on its relationship to other muscles. There can be an effect that you don’t want. When we do Botox™, let’s say for a lip lift, the corners of the mouth are brought downward with aging and with volume loss. And by relaxing a muscle called depressor anguli oris muscle, we can actually get the lip to turn upward. Now if that Botox™ defuses into another area in that same general vicinity, there is possible to effect actual lip movement so it is not unusual to hear about someone having an unusual response to Botox™ when there are several muscles in the area. That’s one of the reason why I stress doctors who really understand facial anatomy and facial musculature and my bias is of course towards surgeons who really understand the depths and level that the injectables that can be performed because we operate directly in that space and know these muscles very well.

This is in contrast to people who have never done that or even non-physician also injecting Botox™. Now that being said, I think that most important thing is really reach out to the doctor who actually did this injection. With the absence of a photo, you can also at least potentially do something to counterbalance the effects of the Botox™ by maybe relaxing other muscles, but hopefully the effect that you are seeing will be a learning experience now that you don’t like Botox™. But in terms of the future the location of the Botox™, the dosage of Botox™ and the effect, our patients who we take care of, we see for years, we get to learn from each visit how they respond and document very well the dosage, the location and the response. We routinely ask our patients to come back after 2 weeks to see the effects and know if this is the right amount for them as customizing and part of a long view relationship with the patient.

This is contrast to unfortunate commoditization of injectable such that people bounce around and chase different incentives. So meet with the doctor, review the photos. When we do anything for our patients, we always take photos and we take photos with movement and expression and then relaxed and document the different asymmetries and then you could at least maybe look at your photos again. Because sometimes, people will notice something different then maybe they don’t know much before because there was a present wrinkle or lines that really was their focus and when that is reduced now, they notice other things. So again I guess I’m stressing over and over the importance of a long term relationship with the cosmetic doctor to at least have a good sense of understanding as well as predictability with your injectable treatments. So I hope that was helpful, I wish you the best of luck and thank you for your question!.

Botox Treatment - How Knowing the Interrelationship of Facial Muscles Helps Prevent Unwanted Results

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Botox Treatment - How Knowing the Interrelationship of Facial Muscles Helps…

Thank you for your question! You submitted a question without any supporting photo so I’m just going to conjecture as to the locations based on your description which you state in your…

By: Amiya Prasad, M.D.