Muscle Recruitment from Botox?

Question

Can you advise if Muscle Recruitment will diminish before the Botox wears off or will it stay in the duration period UNTIL the Botox wears off? I rather opt not to get re-injected within the 2-week check-up period upon my initial injection, but I'd still like to know, for future references, what my options are. Thank you so much, Doctors, for all your help.

Kenneth D. Steinsapir, MD · Answer

This means that so long as there is BOTOX effect (4-6 months depending on dose) there will be muscle recruitment activity in response to your particular treatment. As the effect of the treatment diminishes, the effect of secondary muscle recruitment will also diminish and eventually disappear along with the primary BOTOX effect.

Ron Shelton, MD · Answer

When one set of muscles become relaxed after Botox injections, it can happen that adjacent muscles become more active to compensate for the inactivity of the treated muscles. Sometimes this is seen near the lower eyelid after Crows feet are treated in the outer eyelid area. It also is seen when the middle lower forehead between the eyebrows (glabellar region) is treated and the mid lower forehead contracts and pulls up more causing more of a peaked eyebrow. Usually this compensation goes away in a few weeks, much sooner than the full effect of the treated muscles.

Michael R. Menachof, MD · Answer

I assume what you mean by muscle recruitment is that your result is not exactly what you had hoped for. While the Botox did soften the lines it was supposed to, you now have other lines, elevations, or droopiness in the surrounding area that you didn't anticipate. While no one wants to have to get re-injected in the first 2 weeks, you have to remember why you had the injections in the first place. You didn't get Botox just because you wanted a line or wrinkle to disappear, you had it done because you wanted to look better. If you have had some "recruitment" then my guess is that the overall appearance is not "better". A little bit more Botox should solve this problem. You have already invested time, money, and energy into your injection in order to look better. Why avoid a few more units of Botox when you could be happy with your results now, not 3 months from now. Go back to your injector. Not only will they be able to fix the problem, but they will learn from it as well. Next time, they will be better able to get what you want with a single visit.

Curt Samlaska, MD · Answer

Botox for treatment of wrinkles works by paralyzing the muscle groups that cause the wrinkling to occur. Treatment is selective. In other words, we target specific muscles, such as the vertical frown lines (glabellar region). Paralysis of a set of muscles might lead to recruitment of other muscle groups in an attempt to reproduce the conditioned activity treated by the botox injections — resulting in more prominent muscle activity and resulting rhytides (facial lines or wrinkles) in adjacent regions. This most frequently is observe in the adjacent forehead regions on either side of the "11s," and is often associated with the Corrugator supercilii muscle. A few units of Botox in this muscle often solves the problem.

Steven Wallach, MD · Answer

I do not understand your question exactly?  Soemtimes when using Botox, other local muscles may be recruited in your attempt to elevate or move the muscles treated.

Rebecca Baxt, MD · Answer

I am not sure i fully understand the question. Botox takes about 1-2 weeks to have full effect, and some studies show it takes 4 weeks to peak. Then it gradually wears off. I do find that some patients when some muscles are weakened, get additional muscle recruitment in other nearby areas, thereby causing new wrinkles. This is rare, but I always offer my Botox patients a 2 week follow up to check. If there is muscle recruitment and it doesn't look right, additional Botox usually fixes it. I hope that answers your questions.

William M. Ramsdell, MD (retired) · Answer

This subject is confusing for many. "Muscle recruitment" occurs when new muscles begin to cause wrinkles in areas previously treated with Botox. For example, it is not uncommon for patients to complain that Botox did not completely eliminate frown lines at the glabella. If the Botox was injected properly, what is probably happening is that muscles on the side of the forehead are being "recruited " to create the same frown lines as if the Botox did not work. Press hard over the sides of your forehead just above the eyebrows. Now try to frown. If your frown lines do not appear, then the Botox is working just fine where it was intended. Other muscles are creating the frown lines. Usually you will still look much better than you would without Botox. Unfortunately, treating the areas of persistent movement over the lateral brows will drop the brows .

	 The "Mr Spock" look, with sharply over-elevated lateral brows can occur when just the glabella is treated. In patients with the anatomical predisposition for this, a small amount of Botox can easily be injected over the elevated brow to drop it.

Francis R. Palmer, III, MD (retired) · Answer

It will most likely resolve before the effects of the Botox wear off (around 3 months) but you could have a small amounnt of Botox injected to soften the recruited muscles as well.

Christine Glavey, MD (retired) · Answer

A common "muscle recruitment" side effect of Botox is seen after injection to the muscles of the forehead. The eyebrows may develop a pointed arch. This does wear off much sooner than the (desired) effects of the Botox..usually within 2 weeks. However, I think that most physicians would appreciate it if you could come back in to the office (if possible) and let us correct any "muscle recruitment" asap, as we don't want you to have to live with an undesired outcome. 

	Your physician should document exactly how much Botox is used during each visit, and exactly where the Botox is injected. This will help your physician customize your Botox injection to your anatomy. Everyone is unique (thank goodness), so your injection diagram is very helpful for future reference. And hopefully, this will obviate the need for a return visit. 

	I hope this has been helpful to you. Regards.

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