Bulge in glabella after having Botox. Can this be fixed with more Botox? (Photos)

Question

I had Botox 1 month ago in three area-forehead ,frown lines and smile lines .Two weeks later I notice that U have like bulge between brow which I never had before. I actually didn't have wrinkles at all ,only had Botox to lift the brows .I feel this area now heavy and pronounced and my inner eyelid droopy .Also I look like I am constantly frowning .My question is what went wrong and can this be fixed with more Botox as I certainly don't want to wait e months before it wears off.

William Groff, DO · Answer

I appreciate your concern and encourage you to schedule an appointment with a board-certified dermatologist who is also an expert Botox injector. It is possible you could have additional Botox to correct the heaviness. However, your provider might also suggest you wait a couple more months until the current Botox wears off and then have another treatment to produce a better result. While Botox is a common treatment, the precision of placement and dosing requires extensive expertise and experience to produce an optimal outcome.

Muhammad Mirza, MD (license suspended) · Answer

Thank you for your question.  I'm sorry that your results are not what you expected.  I would recommend following up with a doctor to discuss your concerns.  With a proper evaluation your doctor can determine which treatment options will be best suited for you.  All the best

JBCosmetic - Bristol · Answer

i don't know your history but if you were completely new to toxin treatment, I would have maybe started with a less is more approach. However, it is difficult to assess without knowing the dosages that were administered. When there are not many dynamic lines to treat, less toxin is required and a scattered approach tends to work well for an eyebrow lift.
Your practitioner should be able to advise you and maybe a small amount will help the glabella area. Thereafter, my advice would be to await for the effects to wear off and start with less next time.
I hope this helps
Best wishes 
Julie

Mark Kearns, MBChB, BSc, FRACGP · Answer

Hey there thanks for the question! It does look like your procerus muscle is protruding and if this is the case possibly more injecting in to that area would flatten it out - potentially also with corrugator injections. It does sound like you did have this area injected however but perhaps it was a very small amount. Since it's been 2 weeks now I would go back to your injector for some advice and I'm sure they would be happy to help.

Alex Eshaghian, MD, PhD · Answer

Thank you for your question and for sharing your photographs nadeto. I understand your concern. Botox is a purified protein used to address wrinkles associated with facial expression. When injected into the skin Botox will relax the muscles and smoothen out the overlying wrinkles. The most common areas of treatment are in the upper face. These include the horizontal lines seen on the upper forehead when one raises the brows, the vertical lines seen between the brows when one frowns (frown lines), and the crow's feet seen around the eyes when one smiles.
It is difficult to make an assessment without knowing the dose used and the exact placement of the product. However, I hope the information provided here is useful.The appearance of frown lines is variable from person to person. Usually they are in a vertical orientation but sometimes they can be oblique and sometimes a horizontal line is seen across the upper portion of the nasal bridge. The most common variation is to have two parallel lines, hence the common term "11's" to describe them. But some people have one, three, or more lines. Some people also will see a bulge in the area when contracting the muscle. This bulge is smoothened out after a Botox treatment.
  
The pivotal studies used 20 units of Botox in the glabella area between the brow to address the frown lines. These studies demonstrated that the peak results are seen 14 days after the treatment and most people enjoy their results for 3-4 months. At that point, a maintenance treatment is recommended. While some people start to see results as early as the next day, it can take two weeks for full results so patience is important. We have our patients return two weeks after their treatment to assess their results via photographs. At that time additional units may be added if necessary. If I had a patient with the concern described here I would first want to know the dose and placement of the product. Without this information I would suspect that the corrugators in the glabella were either not treated or treated with too low a dose and that additional units in this area will address the concern.With any injection, there are risks such as pain, bleeding, bruising, redness, swelling, tenderness, and infection. We take special precautions to minimize these risks such as using a painless technique. We also treat bruises with a laser as early as the next day. Bruises usually resolve within two weeks if untreated. After a laser treatment bruises usually resolve in 1-3 days, but may still take two weeks for full resolution. In addition to these risks, with Botox there is also a risk that the product spreads or diffuses to nearby structures. Spread to nearby muscles can lead to side effects such as the temporary appearance of droopy eyelids or a temporary asymmetric smile.
  
After a Botox treatment, I recommend that my patients avoid heat exposure, alcohol consumption, and strenuous exercise for 24 hours and not lie down flat for four hours. This is because all of these activities may possibly lead to the movement of the product and consequent side effects such as droopy eyelids. Although there have been no definitive studies shown that these actually occur and some physicians do not provide such aftercare instructions, in the absence of data I err on the side of caution and recommend that my patients avoid such activities.
  
Please consult with a doctor for specific recommendations. Good luck!

Shareef Jandali, MD · Answer

Without knowing exactly where you were injected, dosage, etc, it is difficult to assess. However, this bulge you are noticing in the glabella may be secondary to lack of treatment with Botox in that area, or too little product injected into this area. Also, if you were only treated on the forehead, your procerus and corrugator muscles may still have movement, still causing you to be able to frown. I recommend following up with your provider to review and to discuss options to correct this.

Rita Rakus, MBBS - Account Suspended · Answer

Hello and thanks for your question. This looks as though you may benefit from further botox treatment- got back to your original injector and discuss your options. Please always seek a qualified and experienced practitioner, Best wishes

Bulge in glabella after having Botox. Can this be fixed with more Botox? (Photos)

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