Was the chin botox overdone? (photo)

Question

I got chin botox 2months and then went in to get my forehead a month later. When I went in, the injector suggested I need more. So in total the first time i received 14 units and then the second time another 14. I didnt like the results the first time and I thought the second time would get better. Now, i noticed its hard to drink water and its hard to smile without my upper teeth showing. Was it over done? Also when i do the face in the pic posted lines show? I also feel like my chin is bigger

Michael A. Zadeh, MD, FACS · Answer

so you got 28 units of Botox just to your chin? That sure sounds like a lot. I usually give between 5-10 units to the chin. It seems that with the excessive amount some of it migrated to nearby muscles and that's why you're having difficulty smiling and drinking. At this point I would do nothing more and just let the Botox wear off. Start over with a more experienced injector next time. Best wishes.

Alex Eshaghian, MD, PhD · Answer

Thank you for your question and for sharing your photograph pugpinky1234. 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.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 in the mentalis muscle on the chin to address a cobblestone appearance or dimpling on the chin. In this area 2-8 units of Botox are used.In the lower face, the depressor labii inferioris (DLI) muscle sits between the mentalis and the depressor anguli oris (DAO) muscles. The DLI muscle is responsible for pulling down the lower lip and it is used when one smiles. If Botox spreads from either the DAO or mentalis to the DLI and relaxes the DLI it can lead to the appearance of an asymmetric smile. Some physicians try to correct it by placing Botox into the contralateral DLI muscle (on the other side). However, I recommend that my patients just wait as the effects go away on their own. 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 say that 28 units in the chin is a high dose and runs the risks described above. Laser skin tightening as described above may help the side effect resolve faster. Fortunately the result is not permanent and I would expect it to go away on its own in anywhere from one week to four 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!

Carmen A. Traywick, MD, FAAD · Answer

Botox lock the release of a chemical called acetylcholine, which triggers the muscle contractions that create wrinkles. Botox essentially paralyze the muscles and stops them from contracting. Results from these treatments are visible within 3-7 days with results that can last anywhere from 3-4 months. Based on the photos that you have provided the results in the chin appear to be normal. You could benefit from injecting your Depressor Anguli Oris, if you are not liking the corners of the mouth pulling down.

Michelle Ellern, DO · Answer

I'm not sure if you mean chin or chin and depressors next to mouth. If it is both then 14 units would be within a reasonable range. I'm not sure why you did a whole treatment at time or touch up unless the botox didn't work.  At this point just let it wear off and go from there.

Melvin Elson, MD · Answer

28 units is a tremendous amount of Botox to get injected in this area.  it will simply have to wear off over the next few months and if you have it done again be sure to see a board certified experienced dermatologist

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