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Significant Indentations from Botox?

asked 10 months ago by wikit626 in Boston, MA
Latest answer by Ronald Shelton, MD
Question viewed 733 times
Tags: eyebrows, female, 3 months post-op, indentation, migraine

I received botox 3 months ago for treatment of migraines. 3 weeks later I noticed a dime size depression over my eyebrow which has gotten worse so that that now it covers an area 1 inch wide & 1.5 inches high, with a spoon-shaped strip next to the nerve that is particularly depressed. That whole area is so sunken that the other side of my forehead looks puffy in comparison. I'm 27. I'm worried because it is getting worse. Is this from the Botox? Can I reverse it? Thank you!

11 answers to Significant Indentations from Botox?

Linear Scleroderma

It seems doubtful to me that this would be a side effect of Botox. I would consider linear scleroderma of the coup de sabre variety as the likely cause. Linear scleroderma is a thickening of the dermis, with the laying down of extra collagen. Unlike its much more ominous relative, progressive systemic sclerosis, linear scleroderma stays "bound" to the skin and does not involve internal organs ( with rare exceptions). It has a 3:1 female to male ratio. The coup de sabre... more

Arnold R. Oppenheim, MD
Virginia Beach Dermatologist

Most likely related to muscle atrophy.

The effects of BOTOX are not permanent. If the BOTOX was effective in controlling the migraines, you may just have to put up with this appearance. BOTOX for migraines is chosen when other treatments have not been effective. If you elect not to have more BOTOX treatment, I would expect this muscle atrophy change to be resolved 6 to 8 months after your last BOTOX treatment. I would recommend discussing this issue with your injecting neurologist to decide if this side... more

Kenneth D. Steinsapir, MD
Los Angeles Oculoplastic Surgeon

Linear depression in the forehead after botox may be unrelated

The temporal issue of noting your linear depression three weeks after Botox should not allow us to quickly dismiss the Botox treatment as a cause, but the Botox itself is not known to cause a depression. So if not the Botox, what could this be? 1. Was there steroid in the injection which got carried off in a vein and caused subcutaneous atrophy so quickly? That has been observed by doctors. 2. Had there been a large vein in the area that had normally provided subcutaneous... more

Ronald Shelton, MD
Manhattan Dermatologist

En Coup de Sabre type of Scleroderma and Botox

Thank you for the photographs. They are very helpful. The first thing that came to my mind was what is called the En Coup de Sabre type of Scleroderma. This is a linear type of scleroderma that one sees on the forehead or scalp. This condition is not related to Botox or to underlying muscle atrophy but rather is a condition that may be associated with certain serologic changes. The cause is unknown, but I would suggest you discuss this with a dermatologist who I... more

Sandy Martin, MD
Fort Myers Dermatologist

This is unlikely due to Botox

The spot you have developed may be linear Morphea and not related to the Botox at all. Go see a good Dermatologist who can help you make the correct diagnosis and get the right treatment.

Mark Taylor, MD
Salt Lake City Dermatologic Surgeon

www.gatewaylasercenter.com

Indentation from Botox to forehead

I have used Botox for over 20 years and have never seen this type of muscle atrophy. I would ask the MD that did your Botox injections if steroid was used as well. This may explain the tissue indentation. IMHO, this is unlikely to resolve or reverse on its own.

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon

Botox indentations after Botox treatment for migraines

The depression or indentation shown in the above photograph would be highly unlikely from Botox. I would see your injecting physician immediately. This atrophy is more apparent in a steroid type injection used for scar tissue or acne and not from Botox. I would discuss with your physician what dilution was used in the injection and if there was any steroid injection used. Did your migraines go away? This looks like steroid atrophy not post Botox injection site!

Michael Elam, MD
Orange County Facial Plastic Surgeon

michaelelammd.com

Botox does not cause this type of atrophy

Thank you for posting the pictures as they are quite helpful in this case. While Botox can occasionally cause muscle atrophy, this does NOT look like what you are experiencing. This looks like a case of "en coup de sabre" which needs to be treated by a dermatologist. Occasionally, you can also see dramatic depressions like this caused from steroid injections. Please see a trusted dermatologist who can help you with either of these conditions.... more

Jacqueline Calkin, MD
Sacramento Dermatologic Surgeon

Botox indentation, Botox for migraines, Botox depression, Botox treatment

It would be highly unlikely that Botox could cause an indentation similar to the one in the photo you provided. Occasionally other types of injections - like steroids for an acne cyst - can cause an indentation. I would see your local dermatologist promptly to help determine the cause of your problems.

Karyn Grossman, MD
Santa Monica Dermatologic Surgeon

Forehead depression after Botox

Botox should not cause a depression of this sort. It looks like a progressive fat wasting condition called coup de sabre. Like a knife scar to the face. If this is the case it can sometimes this can be treated with fat injection.

Steven Wallach, MD
Manhattan Plastic Surgeon

Botox does not cause indentations!

Dear wikit626, the type of marked atrophy of the full thickness of the skin, shown in the picture, is extremely unlikely to be caused by botox. Your dermatologist can best diagnose the exact cause. To me, it looks like either localized scleroderma, or "post-steroid atrophy". There are a few cases in the medical literature , where the simple act of a needle stick in the muscle was followed by localized scleroderma. No cases have been reported following Botox injections , as far as I... more