I had botox for the first time 1.5 months ago to treat frown lines. 32 units were injected between the eyebrows, and another 8 were injected slightly above each eye brow. Now when I smile, I have prominent wrinkles underneath my eyes, where none existed before? What could have gone wrong?
Can Botox Between Eyebrows Result in Wrinkles Under Eyes?
Doctor Answers (9)
Botox injected into the glabellar area that you mentioned is very unlikely to "migrate" to the under eye area. Fortunately, I had a patient with a similar complaint as yours. I luckily had pictures of her prior to the injections of Botox. The pictures revealed, to her surprise, that periocular wrinkles were there before she had the injections.
New wrinkles after Botox.
I would agree that there are two likely causes of your problem. First is the phenomenon of recruitment where once certain muscles have been weakened others try to take over the function of the weakened ones. The second is the all to common phenomenon of seeing things for the first time after a treatment because we are focused on the area as we were not before. This is why all patients need to be photographed before a treatment is performed so a record is made that can be referred back to, you will be amazed and what you did not notice before the treatment.
Botox and wrinkles under eyes
When botox is administered and paralyzes some muscles, it may impact the other protions of the muscle when they strain to perform their function.
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Facial lines and their perception
I do agree that there can be some increased facial movement after botox in untreated areas. There is one other explanation to consider however. If you can get a before and after photo to compare, there is a possibility that with the current lack of wrinkles in the treated area, you may be noticing lines that were there before but were much less prominant when compared with the wrinkles you had in the treated area. For example, sometimes when we treat a patient for acne, then the acne is gone and all of a sudden the patient sees scars. The scars had been there all along, but were not noticeable until the acne was gone!
Eye wrinkles after Botox
It may be that you are overly compensating with the "bunny line" muscles due to lack if activity of the corrugators or procerus. This could be one cause. Otherwise, I do not see an explanation for the observed wrinkling.
Botox for glabella and forehead
Botox when done in the upper forehead and glabella should not be a causative factor in seeing lower eyelid creases suddenly. If the botox injected above the eybrow was around the side and extended to a full Crow's feet treatment , then accessory muscle contraction when trying to squint, may induce more of a lower eyelid contraction.
Can Botox in the frown and forehead result in lower lid wrinkles?
At the doses used, Botox should not travel that far. Even if it did, it should not have skipped all the muscles in between. Either those wrinkles have always been there or something else is causing them.
Botox Injections Require Finesse, and Balance...
I can't answer your question directly, but I will make a couple of comments that might help. A photograph of your eyes before the treatment, and one now would have made this much easier. But apart from that, lets look at a few common issues that I have seen many, many times in 'first-timers' over the past 15 years since I started using Botox (R) (an excellent product in my opinion).
Botulinum Toxin is being provided by thousands of practitioners, not all of which understand the anatomy and the consequences of the treatment in the untreated muscles. Most of the muscles in the human body have a Yin/Yang pairing, where one group elevates and the other group depresses (or flexion/extension, etc- ie goups of muscles oriented to do the opposite of one another). In addition to the anatomy, the human brain exhibits a certain plasticity when a particular muscle function has been inhibited. Simply put, when a muscle is no longer capable of a certain action, the brain tries to re-purpose the adjacent normally functioning muscles to accomplish a particular movement or action. This ability to recruit muscles is sometimes seen in specific areas. For example in the brow, when the corrugators (responsible for scrunching the midbrow and creating 'worry lines', i.e. the 11's seen on photos between the eyebrows), the orbicularis muscle (the thin flat muscle that goes right around the eyelid) can be recruited to cause some of this activity. There are plenty of other examples in the face, but an experienced injector can see these changes, and anticipate them. That's why we recommend that new patients come back for an assessment several weeks following their first treatment to see what is happening. Some people will require a small touchup, and we can then record what should be treated next time to avoid the problem.
The other very common issue is the 'new carpet in the livingroom' phenomena. That's when a new comparison is possible, and all of a sudden you can notice that, gee that wallpaper is looking pretty old too, and the couch looks a bit flabby, oh, and those lamps have got to go...
You start to see the other areas that you never noticed before, because you have a new thing to compare to (and my wife is now redoing our whole living room! Damn you, new carpet.). That is why pre treatment photos are so important- so you can go back and see what was there before but was never noticed.
Hope this helps a bit,
Claudio DeLorenzi MD FRCS
Glabellar Botox Should Not Result in Lower Lid Wrinkles
I cannot conceive a mechanism by which Botox injected into the glabella and forehead would lead to increase wrinkling of the lower lids. First of all, Botox is unlikely to migrate this far and if it did, it should lessen rather than increase wrinkles here. I suspect that you were simply unaware of the condition existing prior to the Botox injections.
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.