David Yew, MD

Botox is the most common treatment because it relaxes the forehead muscles that create the lines. Deeper static creases sometimes respond better to a combination of Botox plus SkinPen microneedling. Asymmetry is normal, please watch our video that we have linked to how we apply it to aesthetics.

Thank you for your question, and I’m truly sorry to hear that you may be developing resistance to Botox. You're not alone—this issue is becoming increasingly recognized, though the reasons behind it remain unclear. In my 18+ years as an injector, having treated thousands of patients, I've personally seen about a dozen who appear to have developed some degree of resistance. Unfortunately, there doesn’t seem to be a common thread—resistance can occur in both men and women, across all age groups, and regardless of whether someone has had only a few treatments or many. There are countless theories circulating online, but as of now, there’s no definitive, evidence-based explanation. We've tried all FDA-approved neurotoxins—Botox, Dysport, Xeomin, Jeuveau, and Daxxify—on some of these patients without significant improvement in efficacy or duration. This makes sense from a scientific perspective since all these products share the same active molecule. If someone develops neutralizing antibodies to that molecule, switching brands typically won't help. It’s similar to comparing different brands of bottled water: the packaging and process may vary, but the core ingredient remains the same. I also urge caution when reading marketing claims or anecdotal stories online. It’s important to verify information with experienced, evidence-based providers before making decisions. In terms of what to do next: some patients choose to take a break from neurotoxins for a year and try again—but often, results are still limited or short-lived. From a financial and satisfaction standpoint, it’s important to weigh whether it’s worth continuing. Instead, many of our patients who’ve encountered resistance have found success and satisfaction through alternative treatments—like microneedling, laser therapy, RF microneedling (e.g., Morpheus8), and investing in high-quality medical-grade skincare. These modalities can improve skin tone, texture, and fine lines—without relying on neurotoxins. I hope this helps you navigate your next steps. You’re welcome to reach out if you'd like to explore alternative treatments that might work better for you. — Dr. David Yew, Aesthetics Hawaii

Based on your symptoms and photo - you are an excellent candidate for TMJ related hypertrophy of the masseter muscles. Be careful to find an experienced provider who knows to avoid the risorius muscle which if accidentally injected - can cause a crooked smile for 3-4 months. Please watch the attached link for more information.

It's important to find an experienced injector. 20 units in my opinion is a lot. I would ask the injector how long they have been injecting Botox. Botox in the chin is relatively straightforward as long as they know the anatomy and stay in the safe area. Please watch the attached video for more information.

Thankfully the effects of Botox are temporary and it will return to normal in 3-4 months. It's important to find an experienced provider who understands the anatomy. In this case - the depressor labii inferiorus muscle was injected and it's the cause of the crooked smile. I'll attach a video explaining the mentalis muscle.

Botox is an effective and safe treatment that can be used to slim the lower face/jawline while also alleviating symptoms related to TMJ -- (clenching, jaw pain, headaches etc....) Please see the supporting link below:

Botox in the masseters can help reduce the square jaw appearance of the face by relaxing the muscles for 3-4 months. It's important to find an experienced provider because if they accidentally inject into the risorius muscle - you may have a crooked smile for 3-4 months. In addition to the slimming effect - it can also alleviate symptoms of TMJ - clenching, grinding, headaches and jaw pain. Please see below link to watch our YouTube video showing how it slims the face with Botox

Botox is a safe and effective treatment to reduce the appearance of platysmal bands in the neck. It's important to find a skilled provider by asking - how many people have they injected in the platysmal bands. There are so many new injectors - it's important to ask. Please watch the link below for information regarding Botox for Platysmal bands.

The botox has worn off and the muscles will start to get stronger and get back to it's original size over the next few months. It's important that your provider took a weight at your treatment so they can compare what your weight is now. People usually fluctuate in weight so it makes a difference if you lost weight. Please watch the supporting link to understand how Botox works for facial slimming.

Good question. First- asymmetry is normal and everyone has this. Like being right handed vs left handed. One is stronger than the other. Please see the attached video for a good explanation. The bulkiness in the lower part of the face can be reduced with Botox. Please see the video on TMJ contouring as well.