Do submandibular glands permanently shrink after injections of Botox/Dysport or is ongoing treatment needed?

Thank you for your question! I think you are on the right track that excess fat was removed during one of your facelift procedures. While it's difficult to see from your photos, I'm not convinced that the bulges are your submandibular glands. Rather I believe the bulges are more likely your digastric muscles, and when the fat between them is removed it creates a "cobra deformity". The best way to treat this is either by reducing the size of those muscles, suturing them together in the midline, or a combination of both. Botox will weaken those muscles causing them to relax and shrink a little, but it will not make the chevron bulge go away. I recommend you be evaluated by a facial plastic surgeon to get a better handle one what is exactly causing the bulging in your pictures, but I suspect Botox will not be a very effective treatment. Best of luck!

Thank you for your question and for sharing your photographs KittieW. I understand your concern. Botox is a purified protein used to address wrinkles associated with facial expression. When injected into the skin Botox will relax the muscles and smoothen out the overlying wrinkles. The most common areas of treatment are in the upper face. These include the horizontal lines seen on the upper forehead when one raises the brows, the vertical lines seen between the brows when one frowns (frown lines), and the crow's feet seen around the eyes when one smiles.It is difficult to make an assessment without a formal exam in the office where I can view the skin in multiple angles and observe wrinkles formed with facial expression. However, I hope the information provided here is useful.While Botox is best known for its use in cosmetic treatments, there are many other indications for Botox including excessive sweating in the underarms, palms, and soles, migraine headaches, cervical dystonia, spasms of the eye muscles, cross eyes, and bladder dysfunction. It has also been shown to help with depression, premature ejaculation, abnormal heartbeats, cleft lips, and pain with intercourse for women.Botox can be used to reduce the size and appearance of the parotid and submandibular glands. similar to when used for cosmetic purposes patients will enjoy their results for three to four months, at which point a maintenance treatment is recommended.With any injection, there are risks such as pain, bleeding, bruising, redness, swelling, tenderness, and infection. We take special precautions to minimize these risks such as using a painless technique. We also treat bruises with a laser as early as the next day. Bruises usually resolve within two weeks if untreated. After a laser treatment bruises usually resolve in 1-3 days, but may still take two weeks for full resolution. In addition to these risks, with Botox there is also a risk that the product spreads or diffuses to nearby structures. Spread to nearby muscles can lead to side effects such as the temporary appearance of droopy eyelids or a temporary asymmetric smile.

After a Botox treatment, I recommend that my patients avoid heat exposure, alcohol consumption, and strenuous exercise for 24 hours and not lie down flat for four hours. This is because all of these activities may possibly lead to the movement of the product and consequent side effects such as droopy eyelids. Although there have been no definitive studies shown that these actually occur and some physicians do not provide such aftercare instructions, in the absence of data I err on the side of caution and recommend that my patients avoid such activities.

Please consult with a doctor for specific recommendations. Good luck!