Cheek filler and masseter Botox - what can I do to get my original face back? (Photo)

Question

I had cheek filler and masseter botox last april and masseter botox again this past november. My face now looks wide and deflated. My eyes are smaller because of blocked lymphatics. What can i do to have my original face back or something close?

Anna Chacon, MD, FAAD · Answer

Thank you for sharing your concerns so openly. It’s understandable to feel frustrated when treatments don’t give the look you expected, especially when changes affect your overall facial balance. Here’s some insight based on what you’ve described:

Cheek filler and masseter Botox effects:
Cheek filler adds volume to the midface, while masseter Botox relaxes the jaw muscle to slim the lower face. Sometimes, if the volume placement isn’t ideal or multiple areas are treated without balancing the surrounding tissues, the face can feel “wide” or “deflated,” and lymphatic congestion can make the eyes look smaller or puffy.

Reversing filler:
If the cheek filler is contributing to unwanted changes, hyaluronidase can be used to dissolve hyaluronic acid fillers safely. This can help restore a more natural contour and relieve some of the pressure that might be affecting lymphatic flow.

Addressing masseter Botox:
Masseter Botox effects gradually wear off over several months, so the muscle will slowly regain its tone and size. This may naturally help your face feel more like it did before treatment over time.

Supporting lymphatic flow:
Gentle lymphatic massage or techniques that stimulate circulation around the eyes and cheeks can help reduce puffiness and improve the appearance of smaller-looking eyes caused by fluid retention.

Planning future treatments:
Once swelling and filler effects are managed, a careful plan with minimal, targeted enhancements—if any—can help restore balance without overdoing volume or muscle relaxation.

These concerns are very common, and with careful management, it’s often possible to get back closer to your natural look while still maintaining subtle enhancements if desired.

Sheryl D. Clark, MD, FAAD · Answer

Dear Practical:

So sorry for what you are going through, It is a difficult thing to deal with an appearance that no longer feels like “me” when you see yourself in the mirror.

It would be helpful during an exam to measure the width and length of your face as well as the height of your chin to the height of the middle and upper face to see if their ratio corresponds to the Golden or Phi ratio of well-proportioned features, as well as examining the strength of your muscles in animation, especially of the chin. From your photos alone, it appears you may benefit from a little neuromodulator to the chin muscles, and some filler to certain areas of the chin and temples to lengthen the height of your face and reduce the prominence of your zygomatic arches. If filler has been placed in subcutaneous tissues rather than over bone in the upper cheeks, one would expect an exaggerated rounding of the cheeks with smiling, and possibly obstruction of lymphatics resulting in a smaller eye aperture and swelling under the eyes. If that is the case, we could consider dissolving some filler with hyaluronidase. At minimum, after the existing filler is resorbed, if any cheek augmentation is needed it could be placed just over the bone for better results.

All the best from New York City, 
Sheryl Clark MD, FAAD

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