Can repeated Botox cause unwanted permanent muscle atrophy?

Thank you for your question. Botox does not have any permanent effects. You could have, however, received a little in an unintended area and now you have muscle relaxation. Normally, it can take 3-6 months for complete strength to return to the muscle. Hope this helps! 

Botox requires precision in both dosing amounts and needle placement to ensure consistency in the treatment. It is possible that your last treatment was slightly off the typical needle spot and you had a bit of Botox go into this area. The medication will wear off in three to four months and the line should disappear at that time. 

botox cannot cause permanent atrophy in the face and it cannot migrate from the eyes to the cheeks but It can change smile/cheek if injected into the wrong facial muscle.
A combination approach would give the most improvement. Movement lines and superficial wrinkles improve best with botox, dysport or xeomin.  Fine wrinkles need lasers like clear and brilliant, fraxel or erbium or co2; radiofrequency like venus viva or intensife microneedling RF; microneedling with PRP and stem cells; aquagold treatment; or soft fillers like belotero, restylane silk or refyne, revanesse versa, or juvederm volbella.  Deep wrinkles can be improved with a combination of Botox and/or fillers for the lines themselves and to build anatomical support with Sculptra for collagen building.  Agressive deep peeling like phenol/TCA and J plasma can be used for deeper scarring or wrinkles.  Ultherapy is great for lifting of this are and thermage is great for tightening and improving overall texture.  Montly facialis like silk peel, dermalinfusion, salt facial, and microneedling with retinol masks can really help fine wrinkles and pore size. You really need a combinaation apporach and proper daily skin care and sun protection for the best results.  Please consult with an expert.  Best, Dr. Emer.

Long term consistent use of Botox may cause some atrophy of the injected muscle. This is due to the muscle being inactive for extended lengths of time. It would be unlikely for the Botox to migrate to a different area of the face and cause atrophy there. It is more likely that the injection site was shifted somewhat and created an undesired effect which will wear off over the next few months.

While the change to your cheek may have been the result of your regular BOTOX injection for crow's feet, it would simply have been the cause and effect of a misplaced injection or a bit more BOTOX than was necessary. There are no permanent affects caused by BOTOX and the injection you received should wear off in 3 to 6 months or so. In the meantime, if you're concerned, you can always reach out to your provider and schedule a check in.
 
 

Thank you for your question ABF90. 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.The pivotal studies used 24 units of Botox (12 units per side) to address the crow’s feet. These studies demonstrated that the peak results are seen 14 days after the treatment and most people enjoy their results for 3-4 months. At that point, a maintenance treatment is recommended. While some people start to see results as early as the next day, it can take two weeks for full results so patience is important. We have our patients return two weeks after their treatment to assess their results via photographs. At that time additional units may be added if necessary. 
Some people have a deficit under the eyes due to loss of or downward movement of the fat pad in the tear trough area. In some cases, the muscle around the eyes serves to hold up the upper cheek fat pad. If this muscle is relaxed with Botox (as it is when addressing crow's feet), this volume deficit can be exaggerated. In these cases, restoring the lost volume with fillers such as Volbella or Vollure under the eyes or Voluma in the cheeks can correct the deficit.
In the mid face, the zygomaticus muscles sit just below the orbicularis oculi muscle which is treated to address the crow’s feet. When smiling, the zygomaticus muscles pull the corners of the mouth upward. If Botox spreads from the orbicularis oculi muscle downward toward the zygomaticus muscles, these muscles can also become relaxed, leading to the appearance of an asymmetric smile. This side effect resolves on its own in 2 weeks to 4 months, depending on the severity. Some find that laser skin tightening treatments using infrared light or radiofrequency may speed up the resolution process.
If I had a patient with the concern described here I would suspect that the placement of the product was not ideal. Some of the treatments described above may be of benefit. I would reassure the patient that the results, desired or undesired, are not permanent and usually last 3-4 months.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!

Thanks so much for your question 
You might had a little pit more dos than what you need
Botox will not cause any permanent effect
It will get better after 3-6 m
Best of luck
Dr Lamia Wassef, Ottawa

I doubt that you had too much Botox. More likely you got s little in an unintended area and you have muscle relaxation. Give this a little time and I bet it will be back to normal. If only Botox would make some muscles disappear we would finally get permanent results. Have never seen it happen