Will this dent/soft spot/atrophy eventually go away after Botox? (Photos)

Question

got some Botox in the 11 lines that didn't really take, so did a touch up a few weeks later and put a small amount in the forehead. Three days after touch up I woke up with a large triangular dent in my forehead. Waited 3 months for it to subside, went to a highly recommended injector who put a small amount of Botox throughout my forehead. Smoothed things out for the most part but I still have a thumbprint sized dent in my forehead that really bothers me. Will it go away?

Hung William Song, MD · Answer

Without evaluating the muscle movement, it is difficult to say for sure, but from your pictures and the history, it looks like the "dent" is actually due to incomplete treatment of your corrugator supercilii muscles.  The #11 lines (gabellar frown lines) are formed by a complex set of muscles. If the central Proceus muscle is completely immobilized and the corrugators are not treated, the corrugators will compensate and work harder causing the muscle to actually enlarge. If you look closely at the photograph you will notice that the dent is actually an illusion caused by enlargement of the muscle just above the inner part of both crows. Instead of treating the forehead, I would suggest having the #11 lines treated again. This should resolve the problem.

Jason Emer, MD · Answer

Yes, once Botox results resolve, this should resolve. Botox results resolve in 3-4 months. See an expert. Best, Dr. Emer

Nelson Castillo, MD · Answer

Thank you for sharing your question and photographs.  If the botox led to some muscle atrophy it should improve once the Botox has fully worn off and your animation returns.  It would be best to then reevaluate your injection pattern to help avoid similar issues.

B. Edward O`Dell, MD · Answer

THanks for your questions and the photo.  It may be that the extra injections have so completely relaxed the muscles that a depression in your skull is now noticable.  I have seen this happen where bony knots or depressions that are hidden with fully functioning muscles are not noted but do get noted after the muscles relax.  I would let the Botox wear off completely and rethink the positioning of your injections next time as well as the amount.  This should correct itself as the Botox wears off.  Hope this helps.
Dr. ODell

Melvin Elson, MD · Answer

This is  very unusual response and is most likely due to relaxation of areas around a dent that was there but covered by the muscle fibers.  rest assured all effects of Botox are temporary and will go away in 3-4 months without residua

Samuel Siddiqui, MD · Answer

Botox paralyzes muscles for 3-4 months.  The Frontalis muscle generally has an aponeurosis in the center of the muscle.  It is possible the paralysis of the muscle as a whole may render the center of the muscle to look different than before, or as a dent.  Also, Procerus muscle is routinely treated as part of the glabellar/ number 11 area and paralysis of this muscle can also contribute to the "dent", keeping in mind that we all do not have exactly the same anatomy of the muscles.  While theoretically repeated Botox injections may produce atrophy of the injected muscles by not using those muscles, it is not encountered in everyday practice.  Botox does not cause atrophy of the fat to produce a dent.  So, in summary it is a matter of the anatomy of the muscle.  Just google anatomy of Frontalis and Procerus muscle.

Leonard Grossman, MD · Answer

I cannot imagine Botox creating this kind of an indent or atrophy if that's what it is after a single treatment. I would definitely submit photographs of your forehead prior to the treatment for an evaluation and a proper treatment options. Good luck from New York City

Darryl J. Blinski, MD · Answer

If after 3 months still seeing this 'dented' forehead area try 1 or 2 vial of Sculptra injections. Fees ib $88 range per vial for the product, pre paid since it must be pre mixed prior to use...

Matthew Elias, DO, FAAD · Answer

Thank you for your question.  That doesn't look like atrophy but rather placement issues with Botox which should resolve shortly as the effect of Botox only lasts approximately 3-4 months.  If it truly is atrophy there are many steps that can be taken including saline injections, deep heating treatments like RF or watchful waiting.  Please follow up with your Board Certified Dermatologist who injected you for further evaluation and management.  Regards, Dr. Matt Elias

Kristine Brecht, MD (license suspended) · Answer

I looks like your injection sites were holding onto the swelling and fluid from the dilution used with Botox.
Try less Botox, and more dispersed.
Yes it will get better, but it may take some time.
Try massaging your forehead 2-3 x/day to help mobilize the fluid.
Kristine Brecht, MD
Seattle, WA

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