NJ ENT & Facial Plastic Surgery

I am not sure its resistance to Botox, but its something to consider. It could simply be the batch that he  tried using.  Especially since it seems you have used Botox before and didn't have this reaction.  I would consider trying one last time, possibly with a different injector.  If he offers to do it for free, then I would consider sticking with the same injector.  Sometimes the Botox rep can help and provide a sample for patients that don't respond appropriately to the medicine.   Alternatively, you can try another product, like Dysport or Xeomin.  Good Luck!

I'm sorry about the Muscle tension Dysphonia. I would certainly see a Laryngologist (an ENT that has extra specialty training in the voice). I am certain there are some in Pittsburgh.  With regards the the nasal tightness, there are things that can be done to "loosen" up the nose. However, it depends on how far out of surgery you are.  If its within the first few months of surgery, its completely normal and does take just a little bit longer to soften up.Good Luck!

Its sometimes difficult to have a nose be less dynamic during smiling. This is because there are many muscles that are moving during smiling. Some are outside the structure of the nose ( like in the cheeks).  If they are excessively pulling on the nose, no surgery would be great in dealing with that. However, sometimes Botox can help in those instances. You would need to be evaluated in person to see if that was a realistic option for your. Other more definitive options include resecting the depressor Septi muscle to help stop pulling on the tip. Adding nasal tip support with grafting can also help, but all of these later options require a third surgery.Good Luck!

I think a physical exam would be helpful to decide if it’s a festoon or just your anatomy. But I don’t see a good surgical correction at this time. Instead the better correction and more reliable solution is to use fillers in that area to camouflage the contour irregularity. Using them above and below the prominence will help to disguise the area. Good luck! 

Thanks for your question. You do have several options. Part of the problem might be that your cheeks don't project enough. In some people either a small cheek filler or an implant can help raise your cheeks and define them.  Alternatively, placing filler along your Jaw line just lateral to the chin could help camouflage them. Finally, carefully placed Kybella might be an option to make your cheeks slimmer.  Good luck!