Dimpling 2 weeks after mentalis Botox? What can I do? (photos)

Question

I had my mentalis injected with Botox about 3 weeks ago, and since the treatment I’ve been experiencing this odd dimpling and indentation. It happens whenever I attempt to contract my mentalis and I can see it whenever I’m chewing, drinking, or talking. I’m so self conscious and hate the way it looks. Is this something that can be fixed without compromising my lip depressors? I’m so upset and incredibly self conscious

Camille Cash, MD · Answer

I encourage you to return to your injector for an evaluation.  The muscles that were not injected are compensating for those that are now relaxed.  A touch up treatment should improve this.

Carmen A. Traywick, MD, FAAD · Answer

Botox  locks the release of a chemical called acetylcholine, which triggers the muscle contractions that create wrinkles. Botox essentially paralyze the muscles and stops them from contracting. Results from these treatments are visible within 3-14 days with results that can last anywhere from 3-4 months. It appears that the mentalis was treated well but other muscles are over compensating. It would be best to follow up with your injector for a possible touchup. Its an easy fix. Hope this helps.

Austin Cosmetic Surgery · Answer

It would appear that some areas treated have relaxed and smoothed, but you still have some bilateral muscle pull causing the “dimple” appearance. This will be more noticeable when trying to rotate bottom lip outwards. With a few more units you should be just fine.

Kathryn Clayton, MSN, APRN, FNP-BC

Kathryn Clayton, MSN, APRN, FNP-BC

Alex Eshaghian, MD, PhD · Answer

Thank you for your question and for sharing your photographs lynnred. 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 in the absence of consistent photographs before and after in the same lighting and angles for comparison. However, I hope the information provided here is useful.Although Botox is most commonly used in the upper face, it can also be used in various areas in the lower face. Botox can be placed in the mentalis muscle on the chin to address a cobblestone appearance or dimpling on the chin. In this area 2-8 units of Botox are used.If I had a patient with the concern described here I would say she is a good candidate for correction with additional units. I would place the product where the muscle is bulging. Likely a higher dose would be recommended next time.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!

Sagar Patel, MD · Answer

You have two options. Wait out the Botox or go back and get some more injected to help even it out. I do forewarn you that injection of the mentalis is far from an exact sciense even in the most skilled of hands so more Botox can make the problem worse.

Jean M. Casello, MD · Answer

You should call your injector to be re-evaluated. This can be addressed by injecting additional botox.

Melvin Elson, MD · Answer

The dimpling you see is easily corrected with another session of botox with a few units so see your injector

Leonard Grossman, MD · Answer

Treating mentalis with botox is a very tricky procedure. Many people wind up with dimpling just like yourself. You need to follow up with your treating physician so they can administer a small amount of Botox the correct this. Good luck from New York City

Dimpling 2 weeks after mentalis Botox? What can I do? (photos)

Answers (8)