More Wrinkles After Botox

I had Botox injected on the sides of my nose. Now, when I smile, I have way more wrinkles under my eyes when I smile. Is there anything I can do to interject those wrinkles?

Doctor Answers 7

Botox injections require an understanding of muscle balance.

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Botox works by paralyzing the underlying muscles which helps reduce the dynamic wrinkles of the overlying skin. When one muscle is paralyzed, it throws off the balance of the remaining muscles. You may need additional Botox injections in to the surround muscles (orbicularis) to help restore this balance. However, at the same time, you do not want to overdo it and loose important facial expression. The great thing about Botox is that it is always temporary. Good luck.

Perhaps the best thing to do is to wait.

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Hi! When a muscle is relaxed with Botox, the muscles next to it can compensate by working harder (and creating more wrinkles) when you smile. I think this is what happened to you.

Injecting a tiny amount (3 units) of Botox into the lower eyelids may help, but it is not risk-free because it can cause the lower lids to droop. That's why the best thing may be to just let the excess Botox effect wear off (2-3 months).

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon

Botox around the nose

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Injecting botox around the nose will get rid of those bunny lines, but in trying to make those faces, other muscles may work harder, will be recruited, and may give you the impression of more wrinkles.

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This is a little odd

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I'm not sure why you had Botox in this area. My guess is that your nose "crinkled" when you smiled. Although this is usually a cute facial expression I can empathize. Now the issue is that the remaining facial muscles are working harder.

My suggestion would be a small amount of Botox around the eyes to limit the extra wrinkles. The best bet next time would be to address the wrinkles around the eyes first.

More lower eyelid wrinkles after bunny lines Botox

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It sounds as if you had your "bunny lines" injected and now your orbicularis muscles are compensating for the diminished muscle activity. You can have the orbicularis injected as well, but this may alter the appearance of your lower eyelids or result in other compensatory lines such as brow elevation.

Give it at least 2 weeks for you to get accomodated to the Botox effect, especially if this is the first time you have had the area injected.

Wrinkles under the eyes

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Botox may help for this area, but you would do well to find a practitioner with experience injecting this particular area. People who benefit from Botox in this area are younger individuals without a lot of loose skin in this area. If there is excessive lower eyelid skin, Botox can actually have a negative effect in this area.

Good luck.

Bryan K. Chen, MD
San Diego Dermatologist

More Wrinkles After Botox Around the Nose

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Hi mpls,

I would examine you carefully both at rest and using your muscles of expression. Only then can a determination of which if any muscles should be treated with additional Botox.

Visit your injecting physician who should be able to make adjustments to your treatment. Your experience emphasizes the importance of being treated by a physician well versed in the anatomy of the facial muscles of expression and the use of Botox.

Good luck and be well.

Dr. P

Michael A. Persky, MD
Encino Facial Plastic Surgeon
4.8 out of 5 stars 36 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.