Can Botox injected too deeply seep into the Zygomaticus muscle?

Question

14 months post Botox, done by inexperienced injector. Initially experienced cheek drop, has slightly improved, but volume in upper cheek never returned to baseline. Also mid-face appears wider as a result. Is it possible that too much Botox injected too deeply could cause Botox too migrate into the Zygomaticus muscle? And, could long term side effects be due to muscle atrophy or the brain simply not remembering how to elevate those muscles entirely. Went from extremely heart shape face to oval.

Harold J. Kaplan, MD · Answer

Hi Anna.  While it's certainly possible that Botox injected to the eye area could have migrated downward into the Zygomaticus, the duration of the Botox would not be causing the concerns you have currently.  Botox won't last more than about 6 months at most which means if you did have any droop in the area (which would more likely show up around the lip) it would be worn off by now.  It sounds like you may need some dermal fillers to give you back cheek volume that has been lost.

Michael A. Zadeh, MD, FACS · Answer

Botox can be injected into any muscle, but there are certain muscles we stay away from because the results will actually be worse. We typically do not inject directly into the zygomaticus muscle, but it is possible that the muscle was inadvertently injected or the Botox migrated into the muscle. In any case, Botox effects only last 3-4 months and things should go back to normal once it wears off. If you are still having issues then you need to follow up with an experienced physician for an in-person examination. Best wishes.

Jason Emer, MD · Answer

Botox results last up to 3-4 months and can be softened with venus legacy and thermage treatments. I recommend getting a formal evaluation with a cosmetic dermatologist. Best, Dr. Emer

Johnson C. Lee, MD · Answer

Sometimes botox can be injected to close to the zygomaticus and affect a full smile. It should last no longer than 4 months and will not cause permanent changes to the muscle or motor memory function. It is possible that during the past 14 months natural aging and/or weight changes can affect how you normally look rather than the botox. I notice this particularly in someone's 30s where facial aging occurs the most rapidly and becomes more noticeable as temporary treatments such as botox or fillers wear off. Hope this helps!
Johnson C. Lee, MD
Board-Certified Plastic Surgeon

Nitai Medical and Cosmetic Centre - Melbourne · Answer

1.Botox in the zygomaticus major muscle will cause cheeks to drop and affect the smile also
2. Effect of botox will last 4 months
3.Not unusual to lose cheek projection with age/lean body . Very easily and effectively treated with dermal filler
4. Cheeks are the foundation of the face. A good treatment will result in indirect improvement of
     -nasolabial folds
    - tear troughs
   - improvement of jowls
   - slight elevation of lips

Can Botox injected too deeply seep into the Zygomaticus muscle?

Answers (9)

Answer: Botox and the zygomaticus

Answer: Botox and the zygomaticus

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Can Botox injected too deeply seep into the Zygomaticus muscle?

Answers (9)

Answer: Botox and the zygomaticus

Answer: Botox and the zygomaticus

Answer: Misplacement of botox

Answer: Misplacement of botox

Browse related questions

Recommended reading

Everything you need to know about Botox

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