Mesobotox procedure on cheeks for open pores - but my cheeks completely got flat - How long would it take to recover?

Question

My doctor has included 40 units total in mesobotox procedure for both the cheeks (20 units per cheek). My cheeks got flat, my smile line is effected, i couldnt smile since months. How long does this dose take to wear off?

Anna Chacon, MD, FAAD · Answer

I understand why this is concerning, especially when the treatment was intended to improve the appearance of your pores and instead changed the fullness and movement of your cheeks.

Mesobotox involves placing very small amounts of botulinum toxin superficially into the skin. However, if the toxin affects deeper or neighboring facial muscles, it can temporarily weaken muscles that contribute to smiling and cheek movement. Unintended weakness of the zygomaticus muscles, which are important for smiling, can result in a weakened or altered smile.

The encouraging part is that this effect is temporary. Botulinum toxin's cosmetic effects generally last around 3–4 months, although the duration varies depending on the product, dose, injection technique, and individual response. Muscle function gradually returns as the nerve-muscle connection recovers.

The fact that you received 40 units total (20 units per cheek) doesn't, by itself, tell us exactly how long your weakness will last because the concentration, dilution, product used, injection depth, and precise locations are also important. I would not assume that 40 units is necessarily an excessive dose without knowing which botulinum toxin product was used.

The flattening of your cheeks can also be explained by temporary weakening of the muscles and changes in how the soft tissues move. It should gradually improve as muscle activity returns.

Because you say that you have been unable to smile normally for months, however, I would not simply continue waiting without having the area assessed by the treating physician or another qualified clinician. Persistent weakness beyond the usual 3–4 month window can occur, but it deserves an examination to make sure there isn't another explanation for the prolonged change.

I would not recommend additional botulinum toxin to try to correct the appearance while you are still experiencing weakness. The safest approach is generally to allow the existing toxin to wear off and reassess your facial movement and cheek volume afterward.

If you develop more generalized muscle weakness, difficulty swallowing or speaking, breathing difficulty, double vision, or other neurologic symptoms, those are not typical cosmetic effects and require prompt medical attention.

So, in practical terms, you should expect gradual recovery rather than a permanent change. If you're already several months out, improvement should occur progressively as the toxin's effect diminishes.

Ajaya Kashyap, MD · Answer

Thankyou for your query. Most effects of botulinum toxin are gone in about five months, some sooner.  Please discuss your concerns with your physician who can examine you and also discuss their experience with “mesobotox”. All the best!

Upavan Pandya, MD · Answer

It sounds like the mesobotox may have affected the muscles responsible for smiling and cheek volume. With 20 units per cheek, it's a fairly high dose, and effects like flat cheeks or smile changes can happen if it spreads too deep.
The good news: Botox effects usually wear off in 3–6 months, and since it’s already been around 10 months, situation would have been normal now.
Light facial massage or muscle stimulation may help in such cases, but mainly it just needs time. If you’d like, we can guide you through recovery and plan safer dosing next time.

Daphney Gracia Antony, MBBS, DipDerm, MScSurg(Ed) · Answer

This simply means a wrong technique of delivery was utilized for mesobotox delivery. The depth of mesotherapy is very superficial hardly just a few millimeters and should not have been deep enough to reach the facial muscles such as rizorius (reason why smile is affected) or masseter (reason why your face has slimmed down). Sadly there is no reversal and might take 1.5-2 months+ for wearing off.

Camille Cash, MD · Answer

I'm sorry to hear of the results from your Botox treatment.  These effects are temporary.  Botox wears off gradually, typically over three to four months for many patients.

Mesobotox procedure on cheeks for open pores - but my cheeks completely got flat - How long would it take to recover?

Answers (5)

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