How do I fix the line/crease/divot in my lower left chin? (Photos)

Question

Why is there a pronounced line/crease/divot in my lower left chin one month after botox which I had to fix the orange peel appearance (see last three pictures to see the final results). In the past, I had the orange peel look (see first picture) and after botox, I did not have the same problem ( see second picture ).

Ella Fedonenko, MD · Answer

I recommend injecting additional 2 units of Botox into the mentalis muscle on the side of the divot to correct this type of asymmetry.

Behnoush Zarrini, MD · Answer

The line you’re noticing is most likely related to how Botox affected the mentalis muscle. Botox smooths the “orange peel” dimpling in the chin by weakening that muscle. Sometimes, if dosing or placement is slightly uneven, one side of the muscle may relax more than the other, leading to a crease, divot, or asymmetry.
The line you’re noticing is most likely related to how Botox affected the mentalis muscle. Botox smooths the “orange peel” dimpling in the chin by weakening that muscle. Sometimes, if dosing or placement is slightly uneven, one side of the muscle may relax more than the other, leading to a crease, divot, or asymmetry.
This isn’t harmful and is usually temporary as the Botox effect balances out and eventually wears off. In some cases, your injector can adjust with a very small touch-up dose to even the muscle pull. If the line persists once the muscle is fully relaxed, collagen-stimulating treatments (microneedling, RF microneedling, or filler in select cases) can help smooth the skin surface.
Key takeaway:The divot is likely a Botox-related side effect rather than new permanent damage. It should improve with time and may be corrected with careful adjustment at your next session.

Erik Peterson, MD · Answer

Hi there! I’m Dr Peterson, a board-certified cosmetic and dermatologic surgeon in NYC. When getting neuromodulators in the chin, the effect is to soften the mentalis muscle and relax the contraction which can lead to dimpling in the skin. If this is not uniformly treated, you can have residual areas of non-treated muscle which can still contract and lead to dimpling. When treating chins, I use neuromodulator but also a variety of biostimulatory fillers and lasers to smooth the area. That’s becausefacial lines form from a combination of repetitive movement, loss of collagen, and thinning of the skin. When topical treatments and neuromodulators aren’t enough, biostimulatory fillers such as Sculptra and Radiesse can be very effective. Unlike traditional fillers that simply add volume, these products stimulate the skin to rebuild its own collagen over time, softening etched lines and improving overall support. To further smooth and refine the surface, fractional CO₂ laser rejuvenation (TotalFX) can be added &mdash; this promotes collagen remodeling in the skin’s upper layers, helping to blur residual lines and create a more even texture.

Anna Chacon, MD, FAAD · Answer

Thank you for your detailed explanation and for sharing the photos. Based on your images and description, here’s what may be happening:

The crease or divot in your lower left chin could be a result of how Botox affected the mentalis muscle, which is responsible for chin movement and the dimpling or "orange peel" effect. While Botox effectively smoothed the peau d’orange texture (as seen in your second image), it may have relaxed the muscle unevenly or exposed a pre-existing volume deficiency in that specific area.

Possible Causes:
Asymmetrical Muscle Relaxation
If Botox was injected unevenly or one side of the muscle responded more than the other, it can cause imbalanced tension—resulting in a visible crease or shadow on one side.

Unmasking of Volume Loss
In some patients, muscle tension may have previously masked an underlying soft tissue depression or scar. Once the muscle is relaxed, that volume loss becomes more apparent.

Over-relaxation of the Chin Muscle
If too much Botox was used, it can sometimes lead to excessive muscle relaxation, creating a slight hollow or droop in specific areas.

Treatment Options:
Dermal Filler: A small amount of hyaluronic acid-based filler can be carefully placed in the affected area to smooth out the crease or divot and restore symmetry.

Rebalancing with Botox: In some cases, adjusting the Botox units in surrounding areas can help even out the muscle tone and correct the asymmetry.

Combination Therapy: Sometimes, a combination of Botox for muscle control and filler for contour is the most effective approach for chin issues.

This type of post-Botox effect is not uncommon, especially when treating dynamic areas like the chin. With the right adjustment, it’s typically correctable.

How do I fix the line/crease/divot in my lower left chin? (Photos)

Answers (4)

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