Botox Muscular Atrophy Between Brows - What can I do to fix this? (photos)

Thank you for sharing your question and posting your photos. With careful placement of fillers you might be able to fill in your “dent”. Make sure an experienced oculofacial surgeon assists with your problem due to the issues of blood vessels in this location. Good luck!

Without knowing exactly how much Botox was injected in the region and how often it was done, I can only surmise from the history that some degree of muscle atrophy has occurred there accounting for the indentation. If this is indeed so, then, in the hands of a highly experienced board certified cosmetic dermatologist injector, an appropriate cohesive, low viscosity HA filler can be used to elevate and smooth the indentation. The is a high vascular region, so it is imperative that an experienced injector be sought ouit. Only this past Thursday, I saw in follow-up a patient I treated with a similar history who was treated as described above with complete resolution of the indentation. Hope this helps.

It is well-established that muscle atrophy (shrinkage) happens consequential to the administration of botulinum neurotoxin (BoNT-A) in the local area. This is said to be temporary and reversible. However, it serves to reason that long-term chemodenervation (paralysis due to the use of BoNT-A), especially significant amounts in the same area, would cause local muscle-thinning; hence causing a relative depression compared with surrounding areas. So, what is the solution in your case? Firstly, stop paralyzing the concerning area (between the brows), i.e. give the muscles are break, and also consider the use of hyaluronate fillers (type low G') to correct the contour-deformity and to keep the skin taut (appropriate consent must be undertaken by the treating physician due to some risks). Also, the use of energy-based devices that would encourage skin remodelling (to improve thickness and tightness) should be undertaken pan-facially, for multiple reasons.