Muscle spasms post botox

Question

I got juveau for the first time on 11/9. I have received botox and dysport many times before and never had any issues as they wore off etc. This time i noticed initially asymmetry in my right eye being my eyelid was much more raised and that eye felt “dryer” post procedure. I got used to it. I am in desperate need of more and noticing when i make certain exaggerated expressions my muscles twitch in my cheeks when i scrunch my nose or lids when i raise brows. Is this them trying to work?

Anna Chacon, MD, FAAD · Answer

What you’re describing can happen as the effects of a neuromodulator such as Jeuveau are changing, although I wouldn’t interpret the twitching as the muscles simply “trying to work.”
Jeuveau temporarily reduces nerve signaling to the muscles. As the medication takes effect and the muscles gradually recover, you may notice subtle differences in how certain muscles contract. This can sometimes feel like twitching, brief spasms, or uneven movement when making exaggerated facial expressions. It can also be more noticeable when some muscles are still weakened while neighboring muscles remain more active.
The initial asymmetry around your right eye and the feeling of dryness are also worth noting. Eyelid position can change after injections around the forehead or glabella because nearby muscles can be affected differently. Dryness can occur if the eyelid or surrounding muscles are not closing or blinking quite as effectively.
Since you’ve had Botox and Dysport many times without this experience, the difference with Jeuveau may simply reflect injection placement, dosing, individual muscle anatomy, or how your muscles are responding this time, rather than indicating that something is wrong.
I would be cautious about getting additional product simply because you feel you need more while you are still seeing unusual contractions. Adding more neuromodulator before the current effects have fully stabilized can sometimes make asymmetry or weakness more noticeable. It’s generally better to assess the pattern of movement and allow the treatment to fully declare itself before making adjustments.
If the twitching becomes persistent even when your face is relaxed, spreads to other areas, or is accompanied by significant eyelid drooping, vision changes, facial weakness, severe headache, difficulty swallowing, or breathing problems, that would warrant prompt medical evaluation.

Camille Cash, MD · Answer

You may be noticing the counter muscle (vs. the treated muscle) reacting when you make exaggerated facial expressions.  As you have not had this issue with Botox or Dysport you may want to remain with those products instead of Juveau.

Stephen Matta, DO · Answer

The muscular system is made up of muscles that work together to help you move and perform various functions. When you want to make a facial expression, like smiling or frowning, your brain sends signals to specific muscles to contract or relax. For example, when you smile, the muscles around your mouth and eyes contract, pulling your lips up and your cheeks in. 
Antagonist muscles are pairs of muscles that work in opposition to each other to create movement. For facial expressions, there are muscles that pull in one direction (agonist) and muscles that pull in the opposite direction (antagonist). After neurotoxin, you will have muscle inhibition of the injected muscles but it won't stop contraction or relaxation of other muscles involved in that expression pattern. 
I would wait until the neurotoxin wears off completely before treating again, unfortunately. In the future, I would only use Dysport at a 1:1 ratio so it does not spread. 
Hope that helps!
Dr. Matta

Muscle spasms post botox

Answers (3)

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