Is there a treatment that can be done to stimulate muscles or atrophied muscle that needs help to rebuild?

Question

14 months ago I had Botox around the eyes and forehead. The injector was inexperienced (caused both cheek drop/brow drop, disfiguring face shape) My cheeks are still not in the high position they once were, and mid-cheek looks wider. There is obviously persistent atrophy or my brain does not remember how to use those higher cheek/orbital muscles. Is there an exercise or treatment that can be done to stimulate muscles that the brain has forgotten to use or atrophied muscle that needs help to rebuild?

Monica Boen, MD · Answer

Botox works by relaxing dynamic muscles that cause wrinkles, so that they stop contracting and folding your skin. Without constant contraction, the muscle does atrophy over time, just as your biceps would atrophy if you didn’t exercise them regularly. However, long term studies have shown that the muscle atrophy is not permanent and when you stop your Botox treatments, the muscle activity may return in 3-4 months. Please consult a board-certified dermatologist who is an expert injector.

Anil R. Shah, MD · Answer

Without standardized before and after photos, this would be hard for any expert to assess. I strongly advise that you seek an in-person examination with an experienced Facial Plastics surgeon who has thorough understanding of facial anatomy.
Best, Dr. Anil Shah

Jason Emer, MD · Answer

This is difficult to answer without pictures. 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. Fillers can be used to improve facial volume. Implants or fat are alternatives. Best, Dr. Emer

Johnson C. Lee, MD · Answer

Botox does not create permanent atrophy or dysfunction of the muscles involved in facial expression. Botox can last for 3-4 months at a time. During this time, people will continue to age naturally with volume loss and facial descent which can be exacerbated with weight changes in their face. When the botox wears off, it may appear that the botox has significantly changed the face, although it is more likely that your natural face is starting to show through. It is best to have an in-office evaluation to determine the best treatment plan to restore a more youthful facial appearance. Hope this helps!

Johnson C. Lee, MD
Board-Certified Plastic Surgeon

Johnson C. Lee, MD 
Board-Certified Plastic Surgeon

Evelyn Feng, MD · Answer

I have not heard of this before. One can stimulate the muscles using e-stim. Many patients receive this along with some facial exercises at physical therapy.   You can even out the cheeks by using fillers or thread lift.

Steven F. Weiner, MD · Answer

When someone has a Bells palsy, there is electrical stimulation procedures to help paralyzed muscles recover. I supposed this type of treatment can work for you too. Fillers will also help. I haven't heard of this much problems after a Botox injection. I suspect it wasn't really Botox, and a counterfeit or lab reagent.

Kristine Brecht, MD (license suspended) · Answer

Interesting question.Botox lasts 3-6months typically, after that the muscles should be back to base line.Face exercises:Squinting the face, lifting the forehead and a good smile showing the teeth should work all the muscles of the face.Best. Dr Brecht

Is there a treatment that can be done to stimulate muscles or atrophied muscle that needs help to rebuild?

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