Botox in lower face gone wrong? Is this normal? (Photo)

Question

I had Botox on my lower face (doctor suggested it to lift my lips upwards), it was my first time. Not only do I see no improvement, it seems to have made the area look worse in terms of loss of volume. A small crease I had to the left of my cheek also looks more prominent. Is this normal?

Jason Emer, MD · Answer

Hi Miranda, I'm not convinced that Botox was the best treatment for your aesthetic goals, but that would better be determined with an in-person consultation. Botox results last up to 3-4 months and can be softened with Venus Legacy and Thermage treatments. If you're unhappy with the overall results, I recommend getting a formal evaluation with a cosmetic dermatologist and facial sculpting expert. The lips, crease, and volume can all be addressed with a combination of treatments. Best, Dr. Emer

Alex Eshaghian, MD, PhD · Answer

Thank you for your question and for sharing your photographs miranda cor. 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.
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 orbicularis oris muscle around the lips to provide a pout to the lips and reduce the appearance of vertical lines around the lips sometimes called smoker’s lines (although they are seen in people who do not smoke as well). In this area 2-4 units are used above the upper lip and 2 units are used on the lower lip. Botox can be placed in the depressor anguli oris (DAO) muscle to elevate downturned corners of the mouth which sometimes produce a sad face appearance. In this area 2-4 units are used per side. Botox can be placed just under the jawline in what is called the Nefertiti lift to relax the platysma muscle which pulls down on the lower face, thereby improving jawline definition.If I had a patient with the concern described here I would want to examine the entire face. It is possible that she would be a good candidate for fillers in the mid-face such as Voluma. I find that Botox in the DAO is a good compliment to mid-face filler treatments but the results are minimal when Botox is performed alone.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!

Center for Aesthetics and Plastic Surgery - Grand Rapids · Answer

Thank you for your question and photos, and I'm sorry to hear that you are unhappy with your results. Neurotoxin treatment, such as Botox, in the lower face can be tricky. Although it is difficult to ascertain from your photos, I'm not sure if that was the appropriate treatment based on your concerns. These results can last typically between 3-4 months, but should resolve once the Botox stops working. At that point, I would recommend scheduling a consultation with an experienced injector for a full facial evaluation to decide the best treatment plan for you. Good luck, and I hope this helps!

Michele S. Green, MD · Answer

Botox is a great injection but I use it primarily for the upper face and masseter muscle and rarely in the lower face.  It sounds as if the Botox hit a nerve in that area and has caused a droop on that side.  It will take several weeks to go away.  Please consult a board certified dermatologist for the best cosmetic results.  Best, Dr. Green

F. Victor Rueckl, MD (in memoriam) · Answer

I really hate this procedure unless it's done on people I know well and know their anatomy really well. I see what you're talking about with the crease. That's because the lip area has moved. Moving a muscle even slightly can elongate other creases and areas. I don't see the Volume loss specifically. But the good thing is that Botox is NOT permanent, and it will resolve in time. In this area in particular I've found it does not last the 3-4 months Botox normally does because the lips just move a lot. So it will go away and return to the way it was before. I don't think you need this procedure again. If you want your lip lifted upwards please consider filler. "This answer has been solicited without seeing this patient and 
cannot be held as true medical advice, but only opinion. Seek in-person 
treatment with a trained medical professional for appropriate care."

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