Botox in chin causing spasm dent. What is this? (Photo)

Question

I received Botox in my chin after being self conscious of little dents wen I smile in pics. Idk what in the world is going on but after I got it, now every time I move my chin (imagine the way you were to pop a pimple on your chin) it spasms up and I have to wait for it to go down before I leave. It’s like a golf ball dent. This happens every morning. Botox never helped the dents either still have them when I smile. Injector nurse refuses it’s related help!

Luke J. Curtsinger, MD · Answer

I believe that you have over-activity of some of the untreated areas of your chin.  You can wait this our for several months and it will likely resolve, or, alternatively, the over-active areas can be calmed with more botox. I am sorry that you are having trouble.  If your injector refuses to help, you may need to seek consultation with someone else.

Gordon Andan, MD · Answer

I'm sorry that your BOTOX® experience didn't produce the results you were hoping for. It could be simply that your BOTOX was misplaced upon injection. Regardless, you should return to your practitioner to let them know of your concerns and to see if there's anything they recommend to help correct your muscle spasms. If they are unable to address your concerns or if your spasms continue, you may want to consider seeking a second opinion from a qualified surgeon or BOTOX practitioner.

Camille Cash, MD · Answer

I'm sorry you are having issues since your Botox treatment.  It appears the concern is from parts of the chin being treated, and others not.  You may see improvement with Botox injected near the area of the indentation.  If you do nothing, the product effects will gradually wear off from the treated area and the look will return to how it was before.

Alex Eshaghian, MD, PhD · Answer

Thank you for your question and for sharing your photographs sferogers. I understand your concern. Botox is a purified protein used to address wrinkles associated with facial expression. When injected into the skin Botox will relax the muscles and smoothen out the overlying wrinkles. The most common areas of treatment are in the upper face. These include the horizontal lines seen on the upper forehead when one raises the brows, the vertical lines seen between the brows when one frowns (frown lines), and the crow's feet seen around the eyes when one smiles.
It is difficult to make an assessment in the absence of consistent photographs before and after in the same lighting and angles for comparison. However, I hope the information provided here is useful.Although Botox is most commonly used in the upper face, it can also be used in various areas in the lower face. Botox can be placed in the mentalis muscle on the chin to address a cobblestone appearance or dimpling on the chin. In this area 2-8 units of Botox are used.A phenomenon seen with Botox is called muscle recruitment and compensation. When a muscle has been relaxed with Botox, sometimes other muscles or a different part of the same muscle are recruited and contract when one attempts to make the facial expression. This serves to compensate for the inability of the primary muscle to contract. Sometimes a bulge can appear in a muscle that was untreated or a part of a muscle that was not treated. A common example is the bunny lines (caused by contraction of the nasalis muscle) that are seen on the sides of the upper nose after treatment with Botox in the glabella or for the crow's feet. Since the muscles in the treated area are relaxed, the nasalis muscle contracts in an attempt to compensate for this loss when one frowns or smiles. In such a situation, the bunny lines can be treated with a small amount of Botox (2-4 units per side). In the upper face, sometimes a portion of the frontalis muscle in the upper forehead which was previously not active becomes active once the muscle is relaxed with Botox. In these case, new wrinkles may be seen, often near the hairline. This can be treated with a small dose of Botox in that area. This can also be seen in the lower face when not enough product has been used in an area such as the chin. Sometimes another part of the muscle begins to contract in order to compensate for the relaxation of the muscle from Botox. This can also be treated with a small dose of Botox in that area. Compensatory recruitment can also occur when the platysma muscle in the neck contracts after muscles in the lower face have been relaxed with Botox. Similarly, this muscle can be relaxed with Botox as well. For my patients, I usually use approximately 10 units per band. If placed properly it does not affect other muscles. Relaxing the platysma muscle may also lead to an improvement of jowls and jawline definition. When such recruitment occurs, I recommend prophylactic (preventive) treatment of the recruited muscles at the next treatment.If I had a patient with the concern described here I would suspect that there is compensatory recruitment of a part of the mentalis muscle that wasn't treated. This can be easily corrected with additional units in the active part of the muscle, seen where there are bulges.With any injection, there are risks such as pain, bleeding, bruising, redness, swelling, tenderness, and infection. We take special precautions to minimize these risks such as using a painless technique. We also treat bruises with a laser as early as the next day. Bruises usually resolve within two weeks if untreated. After a laser treatment bruises usually resolve in 1-3 days, but may still take two weeks for full resolution. In addition to these risks, with Botox there is also a risk that the product spreads or diffuses to nearby structures. Spread to nearby muscles can lead to side effects such as the temporary appearance of droopy eyelids or a temporary asymmetric smile.
  
After a Botox treatment, I recommend that my patients avoid heat exposure, alcohol consumption, and strenuous exercise for 24 hours and not lie down flat for four hours. This is because all of these activities may possibly lead to the movement of the product and consequent side effects such as droopy eyelids. Although there have been no definitive studies shown that these actually occur and some physicians do not provide such aftercare instructions, in the absence of data I err on the side of caution and recommend that my patients avoid such activities.
    
Please consult with a doctor for specific recommendations. Good luck!

Rita Rakus, MBBS - Account Suspended · Answer

Hello and thank you for your question. Botox in the chin is an effective way to relax the mentalis muscle which can help soften chin dimpling and the associated skin texture changes. Without seeing you face to face it is difficult to evaluate exactly what is happening but it would seem you still have some unbalanced muscle contraction in the chin. This will likely resolve on it's own however another option may be having some more Botox placed in the part of the muscles that is still contracting

P. Craig Hobar, MD(retired) · Answer

It is likely that the botox was not placed correctly/evenly. I would suggest returning to your injector to address your concerns. It appears that one side of muscles is hyperactive and firing more than the ones affected by the botox. It may require a re-dosing of botox to help calm the spasms down. I would suggest making sure the office you visit is supervised by a board certified Plastic Surgeon. It should improve! If you do not wish to have more botox, luckily it is temporary and will wear off in 3-4 months from first injection.

Botox in chin causing spasm dent. What is this? (Photo)

Answers (6)