Can Botox in forehead cause vertical lines down across eyelids and then cheeks? Noticed both since first Botox in June (Photo)

Botox  does not address wrinkles in the skin that are present at rest. It addresses dynamic lines, those that are increased with certain muscles movements or facial expressions. Fine lines and wrinkles are sign of aging, worsened by years of inadequate exposure to sun, inadequate skin care, hereditary factors, and worse of all, smoking. Occasionally, Botox unmaskes signs of aging that patients have prior to treatment. In those situations, the answer is rarely additional Botox, but rather, other methods of facial rejuvenation such as skin care, fillers, laser resurfacing, and/or face/brow/neck and/or eyelid surgery.

Thank you for sharing your question and photograph.  I do not feel that Botox caused these vertical lines and would advise a combination of skin care, dermal fillers, and chemical peels to improve the appearance of the wrinkles demonstrated in your photos.  Hope this helps.

As others have mentioned, sometimes using botox to treat one group of muscles can then cause another group of muscles to work harder - which can then cause a *different* set of wrinkles. 

Based on your photos, some of these lines appear to be a result of natural aging, as they are in areas where muscle action is less likely to be the cause. Not to worry: many treatments are available andwould best be determined once you are examined in person. Treatment can include a combination of additional botox, fillers (e.g. Juvaderm) and/or skin resurfacing (e.g. laser).  Whatever you do, please be sure to consult with an expert.

In Good Health, Dr. Cabin

Sometimes Botox can cause lines when compensatory muscles work. A touch up of Botox, lasers and microneedling/prp can help this. See an expert. Best, Dr. Emer

Sometimes Botox can cause compensatory use of other muscles. A touch up on the Botox can help. Sometimes fractional laser and ematrix can also build collagen in the area. 

Best, 

Dr. Karamanoukian

Los Angeles

I don't think these "new lines" are actually new or related to the Botox injection. Often people start to look at their face with a more critical eye after having procedures done and notice things that they didn't notice before. That is why there is an emphasis on picture taking in my office. These wrinkles need laser resurfacing or Infini to be treated and aren't just a quick injection. I'd recommend a good skincare regime which includes Retin A and a good growth factor serum. 

Thank you for your question bertieboogie. I am sorry to hear about your
situation. Botox is a purified protein used to address wrinkles associated with
facial expressions. It is difficult to assess the skin with only after photographs and no before photographs. Sometimes when Botox relaxes a muscle another muscle is recruited and is used to compensate for this relaxation; this may lead to the appearance of new wrinkles. For my patients I usually use Botox to correct such wrinkles. Please consult with a doctor for specific recommendations.
Good luck!

You should first compare these 'new' wrinkles to photographs of yourself before you had Botox, making sure you are using photographs with similar lighting and shadows. I often find that patients begin analyzing their faces very closely after they've had a procedure, discovering new things that aren't actually new. But if indeed they are new, it is because underlying muscles have been paralyzed (that's what Botox does), allowing for new and different manners of skin wrinkling and sagging. I find that most vertical lines in the locations you document photographically, are due to sleeping on the side of our faces. It's not at all easy to do, but Botox or not, if your you could learn to sleep on your back,  perhaps putting pillows under your knees for added comfort, you will almost certainly minimize vertical wrinkles. Don't expect overnight improvement. It takes weeks or months time.

Hi bertieboogie,

I personally don't feel that more procedures (more Botox, lasers, peels) is the answer to your concerns. At least, not yet. I think you need to be seen in person to take a good look at these lines. Are they temporary? Do they go away through out the day? Are you getting more over time? Also, do you have any similar photos before the Botox was done (selfie style, same lighting, etc.)? You should return to the person who did your cosmetic treatments for additional help and guidance. Hopefully you went to a board certified and cosmetically trained dermatologist or plastic surgeon. Good luck!

when you start to do Botox and notice the improvement, many people start to look at their face closer and notice more lines that they perceive as new, but in reality we're there beforehand. I suspect many of these wrinkles are older and not caused from the Botox. A combination of dermal fillers and laser treatment would be best to improve these lines.