Temporal wasting after first time Botox injection for crows-feet, appears permanent, now what? (photos)

Question

Had Botox injections by an MD last September, developed severe temporal muscle atrophy not resolved in 7 mo. Doctor's office denied Botox was the cause, said they'd never heard of this effect, but stated if it was Botox the effects would be temporary, resolving in 3 months, they have not. Currently consulting with PS to repair damage. Reasonable to request MD refund $$$ for improper injections causing this outcome? Apparently this effect shouldn't occur with correct cosmetic use.

Melissa Chiang, MD, FAAD · Answer

Botox can cause temporal wasting if it is injected into the temporalis muscle.  To treat crows feet, Botox is injected into a different muscle called the obicularis oculi.  There are many reasons for temporal wasting.  The most common reason is the natural process of how faces age.  Temporal wasting can also occur in 
response to malnutrition, certain medications, and trauma to the area.With the amount of wasting that you have, I would suggest using sculptra for a natural and long lasting result.  Hyaluronic acid fillers or radiesse are other options.

Jason Emer, MD · Answer

This can easily be treated with fillers to this area.  Please see a meticulous surgeon who has experience in facial contouring. Dr. Emer.

Jeffrey Ridha, MD · Answer

It would be extremely unusual to experience temporal wasting after a single Botox treatment to the crow's feet.  It might occur, if directly injected into the temporals muscle repeatedly over time.  The effects of Botox rarely last longer than 3-4 months, and significant and severe wasting points to another cause, that merits a workup.  I would recommend seeing your primary care physician to help identify the source of the changes you've noticed.  Once you confirm that there's nothing else that needs to be done, there are several fillers that can help improve the appearance of the temples, including Juvederm, Voluma, or Sculptra.

Eric M. Joseph, MD · Answer

You may benefit from visiting your internist to review other causes of temporal wasting with you to ensure this is not a manifestation of a disease process. I have to agree with the consensus that the effects of Botox, especially a single treatment, are completely temporary.You may benefit from an injectable filler treatment to restore lost volume. In our practice we may prefer using Silikon-1000, an off-label filler for permanent results.Wishing you all the best moving forward.

Michael A. Zadeh, MD, FACS · Answer

Botox for crow's feet is not injected into the temporalis muscle. Temporal wasting as a result of Botox is rare and the doses required are much higher than what is given for the crow's feet. Especially after just one treatment. It would be interesting to see your photos before the treatment as a comparison. Fortunately, fillers work very well in replacing lost temporal volume. Make sure you see an experienced injector for this treatment. Best of luck to you.

Evan Ransom, MD, FACS · Answer

Thank you for the question and your photos. Botox can cause muscle atrophy when injected in relatively high doses directly into the muscle mass. In fact, this is how we achieve jaw slimming -- injecting the masseter muscle. For crow's feet, relatively small doses are used and should be placed just lateral to the eye. This is not where the temporalis muscle is located. I would meet with your physician to discuss how the Botox was delivered and in what quantity.

Michael Bowman, MD · Answer

You certainly have dramatic temporal wasting.  I would have to review your injection records and before and after pictures in order to determine if indeed the  Botox were the cause of your wasting.  Normal treatment of the crows feet with Botox should not cause that sort of result.  Common side effects of Botox are little red bumps, swelling and occasionally a small bruise.  Very rarely Botox treatment can cause more dramatic side effects like significant bruising, headaches, and allergic reactions.Muscle wasting is something which can occur with Botox treatments, but that should not occur with treatments of the crows feet.  Sometimes this is used to benefit, like when we treat the masseter muscle for patients with hypertrophic muscles.  If you have any other global/systemic symptoms like weight loss, fatigue, loss of apetite, etc, you need to get an evaluation from your medical doctor as soon as possible.   You have multiple treatment options including Sculptra and Voluma for re-volumizing your temples.  Temporal silicone implants are available as well.  Best wishes, MKB

Harry V. Wright, MD · Answer

In addition to those comments below, I would like to add that I've seen great results with Voluma for temporal wasting (that came from from advanced age and as an adverse effect from certain neurosurgical procedures). Voluma lasts up to 2 years, and may last longer.And like the other commenters, I have not seen temporal wasting from Botox.

Steven F. Weiner, MD · Answer

Temporal wasting is a typical aging process as the fat pads deteriorate.  This can also occur with weight loss, and chronic illness (cancer, HIV, cirrhosis).  The placement of the Botox for crows feet shouldn't go to the temples.  I have treated hundreds of patients for TMJ by injecting the temporalis muscle and still don't have any that have wasting.  Correction of this problem is done routinely in our office with fillers. My preference is Sculptra for this, but can be done with HA's too.

John Louis Ratz, MD · Answer

There are some rising concerns that Botox may cause muscle wasting. This is usually when Botox has been injected multiple times. There are also some animal studies that show that it can cause muscle atrophy, but such studies don't necessarily transfer those traits to humans. However, when muscles are not used for a prolonged period of time, they may develop disuse atrophy. If you google "botox and muscle wasting" you will find sporatic reports. Nevertheless, it's impossible to say for sure why your bi-temporal muscles have atrophied, but I strongly urge you to contact Allergan, the manufacturers of Botox, so you can report this to them. You might also want to consider reporting this to the FDA.  jlr

Temporal wasting after first time Botox injection for crows-feet, appears permanent, now what? (photos)

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