Botox Wearing Off Unevenly - Why?

Question

4 months post-botox- Injected forehead,crows feet/upper cheekbone area, resulting in cheek-drop and eyelid asymmetry. Forehead has worn off weeks ago, and the left cheek has returned to its original position. Unfortunately, my right cheek is still dropped, as well as the right eye-lid. Why has one side worn off weeks ago, but the other side hasn't?Why is there a month difference in the sides returning to normal. If she injected a bit more in one side, would that cause it to last longer?

Aldo Guerra, MD · Answer

At 4 months, it’s time for you to see your injector to get new Botox. Everyone has asymmetric muscles with different volumes and this can happen. Ask your injector to address this concern. Good luck! Dr. Aldo

Ron Shelton, MD · Answer

I do see some of my patients in whom one side may be somewhat relaxed where as the other side is fully awake when they come back for more botox around four months. It's not that unusual. The effect of botox will wear off if no further botox is injected, just give it time. I have seen in my clinical practice of injecting Botox that there  may be some durational effect caused by the number of units per muscle mass but it doesn't mean that if one injects more than the number of units considered reasonable that the duration will be significantly more than four months.
The information provided in Dr. Shelton's answer is for educational purposes only and is not intended to constitute medical advice.  The information provided should not be relied upon as a substitute for consultations with a qualified health professional who may be familiar with your individual medical needs.

Nelson Castillo, MD · Answer

Thank you for sharing your question.  Differing amounts of Botox can certainly lead to asymmetrical wearing off of the product.  Luckily the difference may be a day or two before restoring your previous appearance.  Hope this helps.

Robert M. Tornambe, MD · Answer

Botox usually lasts around 4 months and wears off somewhat gradually, however may still be working in certain areas of your face. Not sure how Botox affected your cheeks, raising them and then lowering them after it wore off. The cheeks and midface are usually treated with fillers like Juvederm or Voluma. Be certain to consult with a board-certified plastic surgeon dermatologist. Good luck.

Camille Cash, MD · Answer

It is common for people to have asymmetrical muscles.  Depending on your anatomy and the amount of product injected, Botox could wear off unevenly.  I recommend returning to your injector to discuss your concerns.

Dennis P. McCracken, MD · Answer

As others have stated, we all have some degree of asymmetry.  It's just that we don't often stared at ourselves so closely in the mirror -- until we get Botox.  There is, however, some concern over placement when you write of a dropped cheek as well as eyelid issues.  These should not happen with correct dosing and placement.  I would give it another month (you've made it this far), then reassess with another, highly qualified/experienced injector.  Make certain to get pre-treatment photos for later comparison to assess just how much of the asymmetry is naturally you.  Good luck!

Michele S. Green, MD · Answer

Botox is an art and a science and it sounds like both the wrong amount and placement of the Botox was done. I am sorry for your problem.  It sounds like it will take at least one more month to wear off and you should not have Botox again until the entire Botox wears off.  Please consult an expert in Botox and other cosmetic injections in the future for the best results. Best, Dr. Green

Leonard Grossman, MD · Answer

Botox effect does appear to dissipate differently in different muscle groups of the face as these groups of muscles are very different. Some muscle groups are much finer and others are bulkier. However, what you see with the cheek drop should not happen at all. It sounds like something was not done correctly. I think you should find yourself a plastic surgeon like myself for your future treatments. Good luck from New York City

Robert L. Kraft, MD, FACS · Answer

The musculature is typically different and few individuals are truly symmetrical.  Four months is beyond the typical efficacy of Botox so it may be time for retreatment.

Steven Wallach, MD · Answer

The botox may wear off a bit differently on each side. It might be time to have your botox redone. ...

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