Botox to fix cobblestone chin is now an indented bump. Any suggestions? (photos)

Question

I had Botox done for the first time yesterday to fix the cobblestone look of my chin that has bothered me for years. I wanted the filler Juvederm Ultra Plus but I was informed that it would not fix the problem, that Botox would be the best option so I took the advice. A day later this is what happened to my chin. Now I have an indented bump and looks worse than before. Is this normal? I

Jason Emer, MD · Answer

It takes a few weeks for the botox to settle in this area.  after 2 weeks if you are unhappy see your physician as to how they can improve the results.  Best, Dr. Emer.

Kyle Coleman, MD · Answer

Botox treatments to the chin can reduce the orange peel or cobblestone look to the chin.  However, it is very important to seek an expert physician when considering these injections.  Injection of this area carries risk of lip droop, difficulty smiling, and irregular muscle action.  In your case, the injections were likely carried out to low and lateral allowing the central muscle to maintain action and creating a bulge from irregular motion.  Seek out an expert and have this portion of the muscle treated.

Barbara L. Persons, MD, FACS · Answer

Great question! Botox takes a few days to "set in". The chin is composed of two major muscles, the mentalis, which is the meaty part of the chin, and the depressor labii, which run along both sides of the chin. To get rid of the "cobblestone" look the injector would need to deliver the neuromodulator (Botox, Dysport, or Xeomin) to both muscle groups. I would wait at least 5-7 days for the Botox to take effect. If by that point you have not noticed a relaxing in the muscle i would notify your doctor. They may inject more to the muscle to reach your desired look.Good luck!

John Mesa, MD · Answer

Botox could be used off-lable to treat cobblestone chi on indentations. Botox takes about 3 to 4 days to start acting. Shape and contour abnormalities 1 (one) day after botox application are very likely secondary to swelling and not to the botox effect since Botox's effect is not stablished ( as mentioned above it takes 3 to for days to activate).

Nelson Castillo, MD · Answer

Thank you for your question and photographs and I am sorry that your results have not fully met your expectations.  At only a day after injection your chin will likely have residual swelling and only the beginnings of Botox effects.  Allow your results time to mature over the next two weeks before assessing your long-term outcome. If after two weeks this persists,additional Botox should be able to correct the poor cosmesis.  Hope this helps.

Donald B. Yoo, MD, FACS · Answer

Botox is very effective for softening the wrinkling and cobblestone appearance caused by contraction of the mentalis muscle.  Botox does take up to a week for full effect, so allow the Botox to continue to take effect before jumping to conclusions.  If after a week the chin continues to have an excessively wrinkled appearance, then additional Botox an be added to further relax the muscle and soften the chin.

Michael I. Echavez, MD · Answer

Botox takes more than a day to take effect, so it is likely that it has not produced any result to your chin a day later.  There can be a mild amount of swelling involved with the injection and this could cause some temporary change in appearance.  You should wait a week or two to see the effect from your treatment.  If you still have concerns after this time, you should return to the physician who treated you to be evaluated.

Marla M. Klein, MD · Answer

Wow your Botox to kicked in fast.  (Was it Xeomin?)  It does look like you will need a touch up as your treated areas look too low and wide;  I typically wait 2 full weeks for Botox to hit its peak to evaluate for touch ups, but I think I would make an exception in your case. Contact your injector, who was hopefully a doctor.  Knowledge of facial anatomy is very important when using botulism toxins to treat the lower face.  You may still opt  for the Juvederm as they can be used together.

Sarat Sabharwal, MD · Answer

Through the careful placement of the injections, the mentalis muscle can be  relaxed to smooth out the dimpled area Botox is a good neuromodulators that stop the receipt of nerve impulses to the muscle so that the muscle stops contracting. This causes the area to relax and the dimples to be less apparent. Patients with especially deep chin dimples and creases may experience optimal results from the injection of facial fillers or a combination of fillers and neuromodulators.

Robert S. Schmidt, MD · Answer

Thanks for your question. I don't have any personal experience with this technique, but I think that you probably have a little swelling related to the injection. It takes Botox about 3 days to start to have any effect at all, so I wouldn't do anything just yet. Best to wait at least 2 weeks before making a decision about what to do, because that will be when Botox has its maximum efficacy. Good luck!

Botox to fix cobblestone chin is now an indented bump. Any suggestions? (photos)

Answers (12)

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