Bulging temporalis after botox - How can I fix this? (photo)

What you are seeing is movement in that part of the muscle since it’s the only part left with movement. You can add more Botox to that part of the muscle, or you could get slightly less Botox in the future to avoid a specific area of muscle strain. 

Thank you for sharing your question and photograph.  It appears that you have remaining forehead muscle which has not be fully paralyzed, rather than your temporalis bulging. I would return to your injector and have them place additional Botox just to the area of muscle still contracting.  Best wishes. 

Based on this single photo it looks like "bulging muscle" is not temporalis but a very lateral muscle bands of frontalis muscle that are left untreated. Sometimes this lateral portion may be purposefully left untreated in order to lift lateral brow and create arch. I am not sure what is the purpose of this type of Botox injection; it should be discussed with your physician or "injector'? This is very easy to treat with additional injection of 2-3 units of Botox into muscle bands. Good luck.

Thank you so much for submitting your question. 
Botox is a wonderful thing, preventing deepening of wrinkles and elimination of dynamic wrinkles. To be honest, botox would not have resulted in your temporals muscle bulging. Likely you just may notice it now that the other muscles of your face are not mobile. It is hard based on your photos to determine what you may be seeing, though it does appear your lateral frontal is still functioning unlike the rest of your frontalis, if that is the case it too could be injected depending on how low it is as you do not want to drop the brow. I think you should make an appointment with your plastic surgeon for an examination in person as this would be most helpful in determining you issue and potential treatment. 

It's hard to tell from the photo but it looks like you are trying to raise your eyebrows.  The only part of your frontalis  muscle that is still working is the part near your temporalis. This makes it look like your temporalis is bulging.  I can't think of a reason for your temporalis to actually be bulging.  For me, you have too much botox in your frontalis.  You should still be able to raise your eyebrows. There's a balance between having a smoother forehead and still being able to move your eyebrows.  

Thank you for your question and for sharing your photograph adavila1990. 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.The pivotal studies used 20 units of Botox in the forehead area above the brows to address the horizontal lines seen when one raises the brows. These studies demonstrated that the peak results are seen 14 days after the treatment and most people enjoy their results for 3-4 months. At that point, a maintenance treatment is recommended. While some people start to see results as early as the next day, it can take two weeks for full results so patience is important. We have our patients return two weeks after their treatment to assess their results via photographs. At that time additional units may be added if necessary. 
The pivotal studies for the horizontal lines on the upper forehead were published many years after doctors had been using Botox. In these studies, 20 units of Botox were used to treat this area. However, in my experience I find that anywhere from 10 to 20 units works well in this area. For patients with narrow foreheads a lower dose may be used and those with a broad forehead generally require higher doses. I have also found that the full results in this area are seen by two weeks. Therefore, we have our patients return two weeks after their treatment to assess the results via photographs. At that point additional units may be used if further enhancement is desired.
When patients present with concerns about specific wrinkles in the upper face such as the frown lines, I always assess and usually treat the other wrinkles in the upper face including the horizontal forehead wrinkles and crow’s feet. The reason is to maintain a harmonious and natural balance to the appearance of the upper face. The muscles in the glabella which are responsible for the formation of the frown lines serve to pull down on the inner brows when a person frowns. Similarly, the muscles around the eyes which are responsible for the formation of the crow’s feet seen when smiling (orbicularis oculi) are also responsible for pulling down on the brows, but in this case the outer brows. On the other hand, the muscle in the upper forehead which is responsible for the formation of the horizontal forehead wrinkles when a person raises the brows (frontalis) serves to pull the brows upward. If one of these muscles is relaxed with Botox and the others are not, the other muscles will still be active. This will lead to an unbalanced and unnatural appearance of the upper face where the brow can be elevated, depressed, or uneven in shape or position. Therefore, I recommend that my patients take a global approach to the upper face when receiving Botox treatments and treat all three of these areas. Sometimes bunny lines on the bridge of the nose are also treated.
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.
Sometimes after a Botox treatment a peaked appearance of the eyebrow is seen. This is sometimes called the Spock or Mephisto look, which makes a person appear surprised or sinister. It is also called the Jack Nicholson look, after the appearance of his eyebrows. This can occur if the muscles that pull the eyebrow down are relaxed with Botox. It can also occur if the upper forehead only is treated. In this case the inner portions of the muscles are relaxed preferentially over the outer portions of the muscle. This allows the outer portions of the muscle to pull up on the tail of the eyebrow. While some people desire this appearance, others do not. This effect can be corrected by placing a small amount (1-2 units) of Botox in the upper forehead approximately midway between the eyebrow and the hair line at the peak of the brow. This relaxes the muscle that pulls up on the tail of the eyebrow, thereby restoring a natural appearance.
If I had a patient with the concern described here I would want to see before pictures and know the dose and placement of the product. Likely the outer portion of the muscle on the forehead (frontalis) was not treated. Therefore this portion is still active and, when active, pulls up on the corners of the brows. The temporalis muscle is not involved here. This can easily be corrected as described above.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!

This does not appear to be your temporalis muscle. Rather the parts of your frontalis at the temples are the only ones not affected by the Botox, while you have had complete paralysis of the remainder. These small areas if the muscle are working overtime, holding up the corners of your eyebrows. The muscle activity can be reduced by additional Botox in this part of the muscle. Since you will have such complete muscle paralysis, you may also need some Botox added below the brows for balance, to keep them from falling. In future, you will either need to include these areas in your Botox injections or use slightly less Botox, without injection as low in the forehead, leaving some brow motion.

It appears from your photos that there is an area that simply needs a bit more Botox. I would return to your treating physician for examination and a touch-up of your Botox.  Please consult an expert in Botox for the best cosmetic results.  Best, Dr. Green

From your photo, it appears that while your central forehead is treated and relaxed, the lateral (outside) areas of the forehead muscles are not, and are exhibiting what now appears to be an exaggerated response when you raise your eyebrows. In my opinion, you might benefit from using less Botox in the central and mid forehead so that you can still move your eyebrows. But if you prefer, your provider can also add a bit of Botox to the lateral sides of your forehead where the muscles are pulling up and causing the straining appearance shown in your photo. In any case, you should speak directly with your provider so that they can help you get the look you are trying to achieve.Best wishes,Pamela Stuart, MD

It would be  better to examine you before giving a definite answer. Injecting botox if the facial muscles is all about balancing the effect. If the central area muscles are too paralysed, then when you try to raise your eye brows, the surrounding normal muscles seem to an exaggerated effect. You may need to decrease the botox dose in the centre or inject a small dose in the temporalis. Best to be discussed over a consultation.