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

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?

Doctor Answers 10

Botox for the chin

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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!

Where is BOTOX injected for "pebble chin"?

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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!

Botox and Results

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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

Jason Emer, MD
Los Angeles Dermatologic Surgeon
4.8 out of 5 stars 207 reviews

Botox injection to chin

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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. 

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

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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.

John R. Burroughs, MD
Colorado Springs Oculoplastic Surgeon
5.0 out of 5 stars 17 reviews

Botox for pebble chin (peau d'orange)

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The muscle that you've highlighted on the image is the DAO - depressor anguli oris.  Botox treatment of the DAO results in elevation of the corners of the mouth.  Injection intended to reduce a pebble chin is performed on the mentalis muscle which straddles the midline of the chin.  On the image you've provided, the mentalis muscles are seen as the paired structures forming a 'V' on the bottom of the chin.  I'd recommend following up with your injector two weeks after your treatment if you are still having concerns about your results.

Chaneve Jeanniton, MD
Brooklyn Oculoplastic Surgeon

Botox Injection Site for Dimpled Chin

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Injections are usually more central or midline for dimpled chin. It can take up to 10 days for Botox to take full effect, so a visit 2-3 weeks after injection would be appropriate. As for reimbursement, that would depend on your doctor. It's possible you may need more than 10 units to get the effect you desire. 

Botox for peau d'orange skin on chin

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The muscle that is treated with Botox to improve peau d'orange skin is the mentalis muscle.  This muscle is located near the midline of the chin and is visible in your diagram.  I usually treat it with two injections of 2.5 units Botox (5 units total) near the midline and low on the chin.  The marks on your diagram show a different muscle called DAO or depressor anguli oris.  The DAO muscle is frequently treated with Botox to help raise the corners of the mouth, but it is not the correct treatment for improvement of peau d'orange skin.

i would recommend that you go back to see your injector and discuss your concerns in person.  If you are not satisfied, I would recommend that you see another injector.  In my practice, all Botox and filler injections are administered by the physician, not by a lesser-trained individual.

Dr. Ort

Richard Ort, MD
Lone Tree Dermatologic Surgeon
5.0 out of 5 stars 28 reviews

Botox for Chin Dimpling

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It would appear that you have had injections not for chin dimpling but to muscles called Depressor Angularis Oris or DAO for short.
This muscle causes the corners of the mouth to be pulled down, so when it is injected, we can see an elevation in the mouth corners.
For the chin, the usual injection point is either a single site in the midline or two injections sites either side of the midline. The normal dose is 3-6 units in total.
i cannot comment on whether you would be entitled to a refund but perhaps your practitioner would be willing to add the additional chin injections complimentary.

Tapan Patel, MBBS
London Physician

Botox for peau d'orange

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Botox for this problem is aimed at the mentalis muscle, that lies in the center of the chin. Raising the oral commisure is most always beneficial from an aesthetic point, so I will treat the mentalis muscle without further complaints. 

Javier Galindo, MD
Spain Facial Plastic Surgeon

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.