What Happens when Botox is Injected in the Upper Cheek Area?

Question

I had my regular crows feet botox done yesterday by a different technician than usual. Usually I have three injections around the outer corner of my eye. She injected twice- one at the very outer corner by my orbital bone, and the second right outside my orbital on my upper cheek. I'm freaked out that it's going to affect my cheek muscle, as well as do nothing for my crows feet. What kind of effect should I expect? And should I ask for my money back?

Brian C. Reuben, MD · Answer

Thank you for your question and photo. The area you are pointing to is an appropriate place for placing Botox to treat lines from the crows feet. It would be unusual for the Botox to create an unwanted effect on other muscles in the area if the injections were done well. Some of your smile muscles start below this, but would be unlikely to be influenced by the injections.

Sam Naficy, MD, FACS · Answer

The area you are referring to in your photo looks like the appropriate muscle around your eye, and depending on the injection technique (done correctly), should relax that muscle and help soften your crow's feet. There is no way of knowing for sure until you see the effects however, and following up if you had any adverse affect would be recommended.

Harold J. Kaplan, MD · Answer

Hi Sugar. The injection location can vary slightly from injector to injector because it is based on clinical judgement. What we would be most concerned about is the result. If the result looks good and lasts for 3-4 months then this was a good injection. If the results do not look good and/or do not last as long, then you would should speak with your injector about the issue. Good luck.

Ken Landow, MD · Answer

so botox yesterday won't produce results for another 7-10 days...if your fingers mark the site of injection, you're okay...some injectors select one site for the entire crow's feet dose and others select as many as 6-8...it's where the problem exists and how severe it is that determines dose...if you get too much in the cheek, it can affect your ability to smile and interfere with lip movement...

Matheson A. Harris, MD · Answer

It is common to inject botox around the areas of the crow's feet, as well as in the upper outer cheek where lines also form when we smile. That is likely what the injector was targeting. If you have doubts, talk with your injector.

Naveen Somia, MBBS, PhD, FRACS · Answer

It is normal to inject some Botox into the upper cheek area to improve your crows feet. No harm done, I would wait to see the effect and then decide. When you start to lose volume in the upper cheek bone area the wrinkles look prominent. In the early stages Botox is effective but eventually one may need some fillers to fix this area .

Jeffrey Zwiren, MD · Answer

There are many small veins in the area of the lateral orbit. When injecting it is important to try to avoid injury to these vessels. So many times the location of the needle puncture is not where the Botox is actually injected. If it was injected too low on the face then the muscles of facial expression can be effected.

Julia Carroll, MD, FRCPC · Answer

The first issue is that you used a "tech" for your injections. At my offices all injectables are done by physicians, most are dermatologists and plastic surgeons. There are many ways to inject Botox and acheive amazing results for the crow's feet. We all have a slightly different technique. I sometimes inject in the upper cheek area but using a very specific technique as this is an advanced injection. It does worry me that you use a tech, get a different injector than your usual and don't seem to trust your facility. Switch to a board-certified dermatologist or plastic surgeon. They are the trusted experts in this field.

Mireille Chae, MD · Answer

The areas you are pointing to may be the points of entry of the needle used in the injections, but the actual injection of Botox would have been most likely some distance from those needle entry points.  There are different ways of injecting and this second person appears to inject a little differently from your other injector.  So you may not have any problems at all with your smile.  I suggest waiting a couple weeks to see the full effects and return to your injector for evaluation if there are any problems. 

	(This answer is not intended nor implied to be a substitute for medical advice.  It is posted for patients’ general education only.  Always seek the advice of your physician or other qualified healthcare provider for further evaluation of your individual case.)

Darryl J. Blinski, MD · Answer

My MAJOR issue is why have a "tech." inject you and NOT a doctor??? I do ALL my BOTOX injections ALWAYS!!!

What Happens when Botox is Injected in the Upper Cheek Area?

Answers (15)

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