Thank you for your question. I understand that you had Botox injections recently, and five days after, you had a massage. The injected areas, which did not have much movement after treatment, suddenly now have movement. You also say you appear to have a dent in your forehead, and you’re wondering if the massage ruined your Botox.I can certainly give you my perspective on this matter as I have been using Botox on patients since 1993. In fact, oculofacial plastic surgeons were amongst the first few doctors to actually use Botox for medical conditions such as benign essential blepharospasm. I am a Board-certified cosmetic surgeon and Fellowship-trained oculofacial plastic surgeon, practicing in Manhattan and Long Island for over 20 years.To give you a bit more understanding as to how Botox works, Botox is referred to as a neurotoxin and is a type A botulinum toxin, which is also in other brands Dysport and Xeomin. Botox works by attaching itself to receptors in the muscle, thus effectively relaxing or paralyzing the muscle depending on how many receptors are affected. The onset of the effect of the Botox can typically be seen in three days, though in some cases it can be seen in as early as one day. The peak of its effect occurs at about two weeks.That said, physiologically speaking, it doesn’t quite stand to reason that a massage would negatively impact the pharmacological or medical effect of botulinum toxin. In terms of the indentation on your forehead, there are cases that when a person’s forehead muscle, or the frontalis muscle, is relaxed, it is possible to see the underlying structure or actual contour of the skull, especially if the skin is relatively thin. Unfortunately, the absence of actual photos prevent me from saying this for certain or speculating further, as there are many other questions that need to be resolved.When Botox is used for medical purposes, we simply inject the patient, have them leave, and not do any kind of special aftercare. When Botox is used for cosmetic purposes, the standard of after care falls into two camps: one says, “don’t move, don’t do anything, don’t even lay on your face” and the other camp says, “move the areas a lot so it will really work.” Based on my own experience of using Botox for 20 years, once the drug is delivered into the muscle, it will do what it is supposed to do, and rarely does it affect adjacent areas, nor does it spread to other areas of the body. I would say that at 5 days, you are probably still in a fairly safe zone.As for the indentation, you may want to evaluate what the cause could be, but I think that it’s unlikely from Botox. As for the return of movement, it makes me question whether or not the dosage you were given was at the level that would’ve been most effective for you. In our practice, we see our patients on a regular basis so I get to know what the right dosage is and what the right locations are that will allow me to create the effect that my patients like. It may be good for you to meet with your doctor and discuss the possibility of having another injection just to see if you can get that movement relaxed the way you like it. Ultimately, I don’t think the massage has had a negative effect on the pharmacological aspect of the Botox, but I do advise that you meet with the doctor who performed this procedure for you so you can discuss your results and properly determine the cause of the indentation.I hope that was helpful and I wish you the best of luck!
