Can repeated Botox cause unwanted permanent muscle atrophy?

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.

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.