Botox Out of Bounds - Grin (or not!) And Bear It

Botox is without question a wonderful product addition to the war on aging.  However, it is not the cure for every sign of facial aging.  While Botox certainly has a place in the treatment of unwanted wrinkle lines that result from normal or over-active muscles of facial expression, there are some places where Botox has no place.

Jowls are caused by sagging of facial skin, and have nothing to do with muscle hyperactivity.  Therefore, it is completely backwards to treat the jowl area with Botox, and a face lift is the proper procedure to treat this condition.  Although many patients have an overactive mentalis muscle that causes unwanted puckering, dimpling, or creases around the chin area, care must be exercised in injecting Botox in the chin area, for fear of distorting the function and appearance of the lower lip area, which may interfere with speech, smiling, oral continence, and normal appearance at rest.  It is much better to "under-treat" and to titrate (adjust) up to the proper dose by administering small incremental doses of Botox until the desired relaxation is accomplished, avoiding the potential for unwanted paralysis.

That's the bad news about Botox outside the normal boundary of use.  The good news is that these effects eventually dissipate as the effect of the Botox begins to wear off.  Although this may take a couple of months, and there is no way of accelerating the process, your appearance should revert to normal.  Until then, you'll have to grin (or not) and bear it.

Keep Botox in it's proper place.  It is not a "facelift in a bottle".

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Botox cosmetic is a safe treatment if performed correctly. A board certified plastic surgeon is ideal for Botox treatments because of our knowledge of the deep anatomy of the face. Injection into areas around the mouth may produce unwanted palliation of normal smile mechanisms. In this particular case, the only thing to expedite the recovery phase is to exercise your smile and wait 3 to 4 months.

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Unfortunatley it sounds like Botox may have been used for a problem that Botox isnt meant to treat. Botox administration around the mouth has to be done very judiciosly, and with a sopecific goal in mind.

Botox cant make jowls go away. Botox used in the proper amount can in some instances relax some of the vertical upper lip lines, or if patients have alot of dimpling in the skin over the chin(hyperactive mentalis muscle) it may be used there conservatively.

I would give follow up to the injector you used so he/she may see the results and in the future consider a board certified provider(plastic surgeon, dermatologist, or facila plastic surgeon).

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Hi  Wendean,

Sorry that you are suffering the side effects of poorly placed Botox.  Your experience again emphasizes the point that Botox injections are a medical procedure that should be performed by a cosmetically trained physician (facial plastic surgeon, plastic surgeon, dermatologist, or oculoplastic surgeon) in a medical office. 

In particular the injection of Botox into the lower facial muscles should be performed by an expert with actual knowledge of the muscles and their function or else you run the risk of complications like you are experiencing.  Unfortunately time is the only thing that will improve the effects of the Botox. 

Like everything else in facial plastic surgery, next time choose your physician most carefully neighbor.  I hope that the esthetician/nurse used a very small dose of Botox and that your problems resolve quickly.  Good luck.

Dr. P

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