After Botox on crows feet, the cheeks turn into a round ball and asymmetrical when I smile

Question

had botox two months ago (10 units on each crows feet which i thought exessive since i usually get 6). i wanted a brow lift, but the ps injected around my eye and no brow lift. puffy cheek when smiling (you can really see the cheek muscle becoming round and puffying out when smiling) btw botox effect began the same night (not sure why botox acted so fast) ,. 2 months later no signs of botox softening. i am worried ill be stuck with this look for a long time.

Kenneth D. Steinsapir, MD · Answer

Who you see makes a profound difference.  Yes, the botox will wear off.  Yes, there are places that botox should not be placed because it causes unwanted effects.  These can take 4 months to fully wear off.  Don't get another bad service to make up for an other bad service.  Please let this service wear off before trying something else.

Sammy Sinno, MD · Answer

The lower injection of Botox for lateral canthal lines, or "crow's feet", can be complicated by diffusion into the nearby zygomaticus major muscle, which is responsible for smiling. The effects of this temporary paralysis will soon begin to wear off, and should be completely gone by 5-6 months after initial injection.

Edwin Kwon, MD, FACS · Answer

The good news is that the botox will eventually wear off, it's just a matter of time. 
The best thing to do when you have unintended consequences from botox is to allow it to wear off completely.  A lot of people jump into putting more botox on the other side to try to achieve symmetry, but this can often worsen the overall results.  Allow the botox to wear off and then seek a provider who is experienced and familiar with the anatomy.

Brent Moelleken, MD · Answer

Your problem is a common one.  When Botox deactivates the lower orbiculares fibers, patients lose their ability to smile correctly, cheeks descend and the lower eyelid fat bags often worsen.Botox is best done by doctors who are familiar with the anatomy of the periorbital and cheek muscles and their actions in the smile and squint mechanism.  Botox is not just for wrinkles; it specifically deactivates muscles to produce an effect.The good news is that the Botox will wear off and it can be redone avoiding this effect.

Gregory A. Buford, MD, FACS · Answer

Without photos, it's really not possible to identify what is going on.  Also, 10 units to each side for treatment of crow's feet is actually a very reasonable amount and much more effective than 6 units/side.  The BOTOX "brow lift" is a very misunderstood treatment by both patients as well as injectors in that it no injection is going to stimulate your brow to raise.  Instead, muscles are selectively injected that normally pull down the brows.  By injecting these muscles you allow the brow to elevate because it is not being actively depressed.  I hope that helps!  -Gregory A. Buford MD FACSBoard Certified Plastic SurgeonAllergan Certified MASTER Facial Injectables Trainer

Jason Emer, MD · Answer

Botox results resolve in 3-4 months. In the mean time, venus legacy treatments can help soften results. See an expert. Best, Dr. Emer

Hardik Soni, MD · Answer

Thank you for your question. Without seeing a photograph it is very difficult to give you advice. However, 10 units to each side of the crow’s feet is a reasonable amount. A Botox brow lift is done by injecting the muscles that normally pull done the brows. Thus, allowing the brow to elevate. Please remember that Botox is not permanent and will wear off in 3-4 months. I recommend having a follow up with your injector to discuss your concerns and determining the best treatment plan for you.

Rebecca Gelber, MD · Answer

I'm so sorry that you have been going through this. Don't despair! Even the worst Botox disasters eventually wear off - the average is 3-4 months though, which is a long time when you're going through it.
Botox is a medical procedure which requires really good knowledge of the anatomy. Although your Botox dose isn't that high, it's all about what your sensitivities are and it sounds like it got injected too low in your crow's feet. If you do go back to the same injector, make sure they know what happened and if you don't feel confident that your injector is a full time experienced person who focuses on best non-invasive aesthetic results, be sure to seek that out in the future.

Michael Hakimi, MD · Answer

This usually happens when Botox is injected a little bit too low under the eyes where the muscle in charge of smiling is inserted. Weakness in that muscle can change the shape of your cheeks and smile. Sometimes it is not even the injectors fault. If you work out or massage your face shortly after Botox injection, it can migrate and affect that muscle. I am sorry you have this discomfort, It will get back to normal after it wears off.

Melvin Elson, MD · Answer

10 units is not really excessive although it is more than I use in this area. it may have been injected a bit low and that is why the appearance you have occurred but will disappear as it wears off. Nothing from Botox is permanent.  as far as the brow lift is concerned there is such a thing as a Botox brow lift which really gives a more pronounced arch to the eyebrows

After Botox on crows feet, the cheeks turn into a round ball and asymmetrical when I smile

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