Laurie A. Casas, MD, FACS

Hi, Your history of right eyelid ptosis repair is very important when evaluating the brow asymmetry. From your photo, it appears that the higher brow may be overcompensating, with increased forehead muscle activity helping to elevate the brow and eyelid. Since your surgery was relatively recent, this compensation may decrease as you continue to heal and your eyelid function and position stabilize. With time, the forehead muscle may not need to work as hard, allowing the brow to relax and potentially become more symmetric naturally. For that reason, I would be cautious about trying to correct the asymmetry aggressively with Botox or proceeding with a brow lift at this stage. I would allow more time for healing and follow up with your surgeon to reassess your eyelid and brow position once things have stabilized.

Hi there, From this single photo, the horizontal line under your chin appears most noticeable with your neck flexed. This type of fold is often related to a combination of normal neck anatomy, skin laxity and the way the skin and underlying tissues compress with movement rather than one isolated problem. The best treatment depends on what the area looks like with your head in a neutral position and on examination. If skin laxity is contributing, treatments such as Ultherapy or Sofwave may improve firmness and skin quality, although they will not completely eliminate a fold that forms with neck movement. Botox is more useful for prominent platysmal bands or downward muscular pull and would not necessarily correct a horizontal crease like this. Similarly, liposuction would only be appropriate if there is meaningful excess submental fat. Because each of these treatments addresses a different anatomical component, I would recommend an in-person assessment before choosing a procedure. A combination approach may ultimately provide the most natural improvement

Hi there, The fullness you’re noticing beside the nose appears to be most prominent when you smile and is likely related to the way the soft tissues of the midface shift and bunch with animation. Recent weight loss may make this more noticeable by changing the surrounding facial volume and contours. I would not recommend treating this area with a neuromodulator based on the appearance in this photo. The muscles around the nose and upper lip play an important role in elevating the lip and creating a natural smile, and weakening them could potentially alter your smile without reliably correcting the fullness that is bothering you. I also agree that simply filling the nasolabial folds would not necessarily address the concern. An in-person assessment at rest and while smiling would be helpful to evaluate the underlying anatomy and determine whether there are other treatment options that would better address your specific concern.

Hi there! Congratulations on your pregnancy. Dysport (like other Botox-type treatments) is usually not recommended during pregnancy. This is not because it is known to be harmful, but because there are no good studies proving it is completely safe for pregnant patients. For that reason, doctors and the manufacturer recommend avoiding it during pregnancy as a precaution. Even though underarm injections use small amounts and are unlikely to spread through the body, the safest approach is still to wait until after pregnancy if possible. Since this treatment is important for you, I would also suggest talking with your OB-GYN. Wishing you a healthy pregnancy, and congratulations again!

Hi there, A subtle indentation near the hairline after many years of Botox is uncommon, but it is not necessarily a sign of poor injection technique. Long-term relaxation of the frontalis muscle can lead to some degree of muscle thinning (atrophy) in certain individuals, and this can occasionally create visible contour changes, particularly in people with thinner soft tissue over the forehead. Injection placement and dosing can influence the pattern of muscle activity, so technique does matter, but these changes can occur even with experienced injectors. An examination is needed to determine whether the indentation is related to muscle thinning, natural changes in soft tissue or bone with aging, or another cause. Since you are already treating only every 7–8 months, your treatment frequency is relatively conservative. I would not recommend reducing the frequency based on this finding alone. Instead, discuss the indentation with your injector. They may recommend adjusting the injection pattern or dose, allowing more of the muscle to remain active, or simply monitoring the area over time. In many cases, muscle bulk gradually returns if Botox is discontinued or spaced out further, although recovery varies from person to person.

The folds you’re describing are often the result of the way several muscles around the nose and upper lip work together during smiling, rather than a single muscle. If Botox to the depressor septi nasi made them more noticeable, it’s possible that changing the balance of muscle activity allowed other muscles, such as the levator labii superioris alaeque nasi or the nasalis, to become more prominent. This doesn’t necessarily mean the original treatment was incorrect—facial anatomy and muscle interactions vary significantly from person to person, and occasionally relaxing one muscle can accentuate movement elsewhere. Before considering additional treatment, I would recommend an in-person assessment with an experienced injector who can evaluate your facial movement at rest and during animation. Depending on the underlying cause, the best approach may involve a different injection pattern, a more conservative dose, or, in some cases, a treatment other than Botox. A dynamic evaluation is the best way to determine what is driving the folds and how to address them safely.

Hi there, Based on your photos, your mental crease appears to be a structural feature rather than simply a superficial wrinkle, which is why filler alone may not completely eliminate it. This type of crease is often influenced by a combination of your natural chin anatomy, soft tissue attachments, and activity of the mentalis muscle. In many cases, the best results are achieved with a combination approach using a neuromodulator to relax the mentalis muscle and strategically placed hyaluronic acid filler to provide structural support and soften the crease rather than simply filling the line itself. If the crease is tethered, subcision may also be considered in select patients. An in-person consultation with an experienced injector is the best way to determine the underlying cause and develop a personalized treatment plan that provides the most natural-looking improvement.

Hi there, Based on your description, it doesn’t necessarily mean the product itself was the issue. If the forehead responded well but the glabellar (“11”) lines showed little improvement—even after a touch-up—there are several possibilities. The glabellar complex is one of the strongest muscle groups in the face and often requires precise placement, appropriate dosing, and occasionally a different injection pattern based on an individual’s anatomy. In some patients, untreated accessory muscles can also continue to pull, making it seem like the treatment didn’t work. While true resistance to botulinum toxin is possible, it’s relatively uncommon, especially if other areas treated during the same session responded as expected. If you’ve had good results with the same product in the past, it’s less likely that the brand itself was the problem. Before switching products, I would recommend seeking an evaluation from an experienced injector who can assess your muscle movement in person. They can determine whether the issue was related to anatomy, dosing, or injection technique, and discuss the best approach moving forward.

Thank you for sharing your photos. While it is difficult to comment on exact dosing without an examination, prominent platysmal bands often require more treatment than patients expect, and the appropriate dose can vary significantly based on the strength and thickness of the muscle. In my experience, the more important factor is not simply the total number of units used, but ensuring that the entire length of the active band is adequately treated. If portions of the band remain untreated, residual contraction can continue to make the bands visible. It’s also important to have realistic expectations. Neurotoxin can soften and relax platysmal bands, but it may not completely eliminate their appearance, particularly if there is underlying skin laxity, excess tissue, or structural prominence contributing to the contour. I would recommend discussing your response to treatment with your injector at your follow-up visit. Additional dosing may be helpful, but whether 10 more units will achieve your desired result depends on the anatomy being treated and the degree of residual muscle activity present at the time of evaluation.

Thank you for sharing your photos. Based on the images provided, the lines appear to be primarily crow's feet and lateral lower eyelid wrinkles. These lines are typically caused by a combination of repetitive muscle movement from smiling and squinting, age-related loss of skin elasticity, and thinning of the skin around the eyes. Treatment options depend on the severity and whether the wrinkles are present only with animation or at rest. For dynamic crow's feet, neuromodulators such as Botox are often the first-line treatment. If the lines remain visible at rest, treatments that improve skin quality and collagen production—such as laser resurfacing (CO2, erbium, or fractional lasers), chemical peels, microneedling, or radiofrequency-based treatments—may provide additional benefit. In some patients, a combination approach yields the best results. An in-person evaluation would be needed to determine whether skin laxity, volume loss, or muscle activity is the primary contributor and to develop the most effective treatment plan.