Where is the correct location for Botox injections of a pebble or peau' orange chin? (photo)

Question

The doctor injected 10 units & placed it on the sides of my pebble chin (see below). I felt this was off. Its been a week now and I notice no difference in my pebble chin but the sides of my mouth seem more raised. I don't believe the doctor injected it in the correct location. What is the correct location for my future knowledge? How soon would you recommend I go back to have it injected in the correct location? Would the doctor's office reimburse me for incorrectly injecting my chin?

Gregory A. Buford, MD, FACS · Answer

As the other physicians stated, the injection that you received was most likely targeted at the DOA muscles.  When these are weakened, the depressors at the corners of your mouth relax and the area then tends to lift slightly giving your mouth a gentle upturn.  To effectively target the "pebble chin" or orange-peel chin (as it is more commonly referred to), the midline mentalis muscle can be treated with as little as 4-8 units of BOTOX Cosmetic with effects seen within about 3-5 days.  I would speak with your initial treating physician and illustrate your concerns.  I'm sure they will take good care of you.  I hope that helps!

Jason Emer, MD · Answer

Treatment for "pebble chin" is Botox injected into the mentalis muscle which is located more midline and lower than the injection site your physician used. Botox takes 10-14 days to see optimal results and 3-4 months to resolve. If you are unhappy I suggest discussing your concerns with your physician, or seeking the opinion of a second board certified dermatologist. Best, Dr. Emer

Alex Eshaghian, MD, PhD · Answer

Thank you for your question scutebb. Botox is a purified protein used to address wrinkles associated with facial expression. Botox can be used in the lower face to address a number of concerns, for example the dimpling or peau d'orange of the chin or elevating the corners of the mouth. In the center of the chin, directly under the lower lip, lies the mentalis muscle. It may be a single muscle or it can be two muscles side by side, there is anatomical variation. When the mentalis muscle is relaxed with Botox, one can see improvement in the dimpling of the chin. Adjacent to this muscle on either side is the depressor labii inferioris (DLI), which pulls down the lower lip. It is important to avoid this muscle because if Botox spreads to this muscle one is not able to pull down on the lower lip and an asymmetric smile can be seen. Going further along the jawline toward the ears is the depressor anguli oris (DAO), a muscle that pulls down the corners of the mouth. Over time this muscle can get strong, pulling down on the corners of the mouth and giving a sad face appearance. When the DAO is relaxed with Botox, the corners of the mouth are elevated by about a millimeter. Here also care must be taken to avoid the DLI so it does not result in an asymmetric smile. Most people enjoy their results for three to four months. If  the intended muscle was not treated fully, it can be retreated after two weeks. Reimbursement policies vary from office to office. Please follow up with your doctor for specific recommendations. Good luck!

Shaun Patel, MD · Answer

The proper injection site for a cobblestoned chin or peau d'orange appearance of the chin is the mentalis muscle which is indicated by the two bands located centrally and directly over the chin on your diagram. The muscles you have marked with an X are the DAO muscles and injection into these muscles will cause an upturn of the corners of the mouth. My typical injection for cobblestoning of the chin is 6-9 units of Botox injected into the mentalis muscle using 2-3 separate injections.

John R. Burroughs, MD · Answer

I would give it another week and if your not pleased with the result then I would let the injector know.  Wrinkle blockers take about 2-3 weeks to get to maximal effect. Your diagram shows the injection sites or the DAO muscles and it will help give a gentle upturn to the outer corner of your mouth.  The injections for the dimple or peau d'orange are more central and a bit lower to avoid causing the centro-lateral lower lip to raise up.  Oftentimes only 4-6 units are needed for Botox or Xeomin and 12-18 for Dysport.  Best regards.

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Where is the correct location for Botox injections of a pebble or peau' orange chin? (photo)

Answers (10)

Answer: Botox injection to chin

Answer: Botox injection to chin

Answer: Wrinkle blocker injections for pebble or peau d'orange chin.

Answer: Wrinkle blocker injections for pebble or peau d'orange chin.

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Our mission is to create a world where every investment in modern beauty is Worth It.