Sarah Schram, MD

Infiltrative BCCs are often wider and deeper than they appear to the naked eye.  I would strongly recommend surgery and suggest Mohs surgery by an American College of Mohs Surgery member.  Cure rates for Mohs approach 99%.  PDT will likely not penetrate deep enough to treat your tumor and has a much higher recurrence rate.  

The symptoms you are describing are not typical side effects from Botox and are most likely unrelated to the injections.  I'm sorry you are not feeling well, if the symptoms continue I would see your primary care doctor.  

If the scar is thickened or red, Biocorneum (or other silicon scar products) can still be helpful.  It should be massaged into the scar twice a day for 6-12 weeks.  If the scar is flat and white or depressed, it will likely not help.  In that case a fractionated laser could be helpful with texture.  

Given that he has been treated for an infection and it is has not improved I would consider a diagnosis of erosive Pustular Dermatosis (EPD).  EPD is an inflammatory condition that can occur after significant trauma (such as from surgery) to the scalp.  It is typically treated with very strong topical steroids and should improve.  I would recommend follow up with a Mohs surgeon or board certified dermatologist.  

If the scab is starting to lift at the edges, I would expect it to fall off within the next 1-2 weeks.  Do not attempt to pick or pull it off as that might damage the graft underneath.  I would keep the area hydrated with vaseline.  I would recommend following back up with your surgeon though so that they can make sure you get optimal cosmetic results.  

Congratulations on your weight loss.  I think a combined approach of Botox to the wrinkles that occur with facial motion (smiling, etc) and perhaps some filler to your cheeks to add a bit of volume back may help.  I would definitely recommend an in person consultation with a Board certified Dermatologist or Plastic Surgeon to make a plan specifically tailored to your needs.  

It is possible to develop antibodies to Botox or other neurotoxins which can lead to them not working.  This would be fairly unusual though if you have never had it before.  How well Botox works depends on the exact placement of the Botox and the amounts used.  I would recommend letting the Botox you have wear off completely (about three months) and then you could try again.  Would highly recommend seeing a Board certified Dermatologist, Plastic Surgeon, Oculoplastic, or ENT physician and let them know the issues you had.  

Eyelid and eyebrow droop are more common if you have a shorter forehead, naturally low set brows/eyelids or if the injections were placed too low.  If this was due to low injections you may be able to try again with a change in injection points.  I would follow up with your injector so they are aware this occurred and they may give you some eye drops to help.  

Swelling post injections can be quite dramatic in the first 24-72 hours.  It is actually a great sign that the Kybella is working.  The major swelling should start to go done after 3-7 days but some smaller residual swelling my last for even a few weeks after.  Ice can help with discomfort.  

Great Question.  Yes, you should see improvement by then.  Most people require 2-4 treatments spaced 1-2 months apart.  The number of treatments depends on the size of the area and I would recommend a consult with a board-certified dermatologist.  I would not recommend having any treatments in the 6 weeks leading up to the wedding so that all swelling has fully resolved in time for the big day.