Eric S. Weiss, MD

Hi, thank you for your question. Botox is temporary and a lip flip should have little permanent effect on your skin. In this particular picture, I cannot see what you’re referring to. But you have 5 options. 1- continue waiting a couple of months and re-evaluate, your opinion may change after all residual neurotoxin has worn off. The toxin can affect different areas of the muscle differentially so any laxity or irregularity may change when your body normalizes. 2-repeat the procedure, if you liked it you could expect a similar result. 3- you could consider filler which can add a bit if volume and disguise excess skin. 4- consider a skin tightening procedure. In my office I have several but one is radiofrequency microneedling which stimulates collagen and can tighten the skin. Lastly if skin excess is significant, a surgical lip lift where a narrow segment of excess skin is removed below your nose, could be could be considered. Which option is best for you is dependent on a personal in person evaluation and also your own preferences.

-Dr. Weiss

Hi thank you for your question. There are four available FDA approved neurotoxins in the US some of which have different properties. Of these, dysport has the fastest speed of action. If faster onset is important to you, and you haven't tried that, I would consider it. The toxins work similarly by limiting reuptake of a chemical that mediates transmission and impulse to the muscle. In theory moving your face more could speed to depletion of the chemical leading to faster action, but this doesn’t actually have much of an affect in my experience. Mainly toxin used and time are the important factors. People react a bit differently to different neurotoxins as well, one may be more potent or less affective for some people than others. So it may he worthwhile to try another type if you’re only familiar with botox.

Hi,
Thank you for the question. Tear trough injections are sometimes problematic and unfortunately your concern is not uncommon. The skin below the eye is extraordinarily thin, and injection of filler in the area requires a lot of precision in the proper location, sufficiently deep, in the appropriate quantity with the right amount of filler. Injecting too much, too close to the skin, and not evenly dispersed can cause irregularities. Within having seen you in person I can’t say for sure, but I would likely recommend this be dissolved and properly reinjected, either with filler or fat grafting. I would probably not inject more to try to camouflage it, that could make matters worse. There is little harm in dissolution.