Lillian Overman, MD

Hello,

Correcting chin lines and dimples is a common, albeit off-label, use of Botox.

Best regards,

Lillian Overman, MD 

You ask a very interesting question.

There are multiple causes of tibial nerve compression, most of which would not be impacted by Botox. However, if your podiatrist or orthopedic surgeon believes that muscle tension is playing a role in compressing the tibial nerve, relaxing the offending muscle might help. Conditions like plantar fasciitis are aggravated by muscle tension so that is why Botox can lessen the symptoms. If you are asking if Botox can block sensory nerves from carrying pain signals to the brain, the answer would be no.

You don't mention when the second cc of Juvederm was injected, but if it was shortly after the first cc, that would be 18+ months ago and the lump shown in your photo is larger than I would expect this long after injection.

If the lump is indeed due to residual Juvederm, then an adequate volume of the enzyme hyaluronidase should dissolve it and your lip should return to normal. This would be both diagnosis and treatment in a single step. 

On the other hand, if hyaluronidase does not dissolve the lump, you will need to have a tiny biopsy done to determine its composition. One possible cause is the formation of a granuloma (sort of like a ball of scar tissue). An oral surgeon could do such a biopsy in the US. I'm not sure about the UK. 

Hope the lump just dissolves with enzyme treatment..

Lillian Overman, MD

Your symptoms may not be due to Volbella especially this long after your injection. Their episodic nature and your photographs suggest cheilitis granulomatosa (Miescher's cheilitis) or angioedema. You should follow up with your primary care physician or an allergist. 

Good luck.

Best regards,

Lillian Overman, MD

Hello,

What you describe doesn't sound normal, but it's hard to get a clear picture without more details. Firstly, the trapezius muscle isn't in the front. The nerves that travel from the neck down to the arms aren't in the front either. Botox shouldn't be causing swelling in your armpit. I'm concerned that there is more happening than trapezius muscle spasm; such as compression of the nerves that travel down your arm as well as the vein and lymphatic vessels that drain the arm. Consider a second opinion with another neurologist and an appointment with your primary care physician.

Please let us know how you are doing.

Best regards,

Lillian Overman, MD

Because it has taken this many years for you to notice the asymmetry, it is not particularly noticable. We are all asymmetrical and subtle asymmetries are one of the things that makes us unique. 

A tiny bit of Botox under your right eye might make it look more like the left, but if it were my face, I wouldn't bother.

Panda, your idea is a good one. Even though a night-guard could protect your teeth from damage, the force on your jaw will prematurely damage your jaw joints (TMJs). I have found Botox to be a very good treatment for this condition. It has helped to break the grinding habit in several of my patients as well as protect their teeth and jaws joints.

The chewing muscles are located at the corners of the jaw near the ears. When these muscles enlarge (hypertrophy) it can give the face a heavy and masculine appearance. I have as many patients asking for Botox to improve their facial shape as to treat bruxism. The face ends up being more oval.

The effect of the Botox should be gone by now. 

You should see an ophthalmologist because droopy eyelids can be caused by neurological problems such as myasthenia gravis. Once disease has been ruled out as the cause, you should ask about the suitability of having an eyelid lift (blepharoplasty). If your eyelids are obscuring a significant degree of your visual field, this procedure is likely to be covered by your insurance.

Good luck,

Lillian Overman, M.D.

Fillers disappear gradually not suddenly. The longevity varies widely depending on the patient. 

I am sorry that you don't like your results and you have been looking at the area for 10 months. It isn't that difficult to dissolve filler and I have never seen lumps from dissolving with hyaluronodase. Since the appearance of the filler bothers you, why don't you have it dissolved?

The duration of a filler's effect depends on which filler is chosen. Some fillers are permanent, some last years and some last months. 

The most common fillers are made from hyaluronic acid (HA); these are broken down by a specific enzyme in our body so the duration of effect depends on:

1. The number of bonds and/or the size of the HA molecules in a particular filler: Not surprisingly, more bonds and/or larger molecules take longer to break down. Sometimes my patients will ask me to use a long lasting filler in a specific location (for example Voluma in the lips); however, filler must be selected based on the location it will be injected. In this example, if Voluma is placed in the lips, the result would be unattractive because the Voluma's consistency is too stiff for that location. 

2. The level and quality of the enzyme that breaks down HA in a particular person (hyaluronodase or HAase): There is a natural variation in hyaluronodase level and efficacy from person to person. Some people make more, some people have slight structural variation that make their enzyme work better than another person's enzyme.

3. The location that the filler is injected: For example, the earlobes don't move very much and don't have a great blood supply. It seems like filler lasts years in this location. I have a patient whose ear lobes I injected with a hyaluronic acid filler 7 years ago and they still look terrific. On the other hand, the lips are very vascular (have a good blood supply) and move a lot. The same filler that has lasted 7 years in my patient's earlobes lasts an average of 9 months in the lips.

4. The volume of filler injected: The reason why volume matters is that the enzyme (HAase) can only chisel away at the surface of a clump of filler while the inside (volume) is protected. As an object (or clump of filler) gets larger, it has less surface area in relation tovolume. To understand this, it may help to consider how easily babies get cold compared to adults. A baby has more surface area compared to its volume than an adult so babies loose heat more quickly and are at greater risk of becoming dangerously cold. Applying this principle to fillers means that a little bit of filler will be eroded more quickly than a large cluster of filler. Two syringes injected in one location last longer than one syringe in the same location.

Patient often think that doctors can control how long a filler lasts. Unfortunately this is not true; the determining factors are the patient's choice of filler, the choice of location, how much they want or can afford and factors inside the patient's body. Of course, your doctor should be educating you so that you can make an informed choice. You should know the name of the filler you receive, the filler's average lifetime and the volume you receive. Like many things in life, you get what you pay for. In your case, the low cost you paid did not include an adequate explanation of what you were getting.

I am concerned that you mentioned Canada in your question given that you live in Arizona. If you travel to Canada and get injections there, that's fine. The same filler made by the same manufacturer should have the same properties and be as safe as that filler in the US. The problem is that it is illegal for a physician to import drugs from other countries. A physician who is willing to break this law, may also be willing to cut corners on other aspects of medical treatment.