Casas Aesthetic Plastic Surgery

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, 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, 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 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.