Weird dimple in chin after receiving two injections of restylane and some botox? (Photos)

Thank you for your question. You submitted two photos, and describe a weird chin dimple after undergoing Restylane and Botox® for your chin to improve the appearance. You state the chin looks normal when you smile and when you have no expression, but when you frown or scrunch your face there’s this strange dimpling. You’re asking if you should go back to your doctor, or are the fillers still settling.
I can share with you my perspective based on this limited view of your situation, in the absence of a physical exam. A little background: I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial plastic and reconstructive surgeon. I have been in practice in Manhattan and Long Island for over 20 years. Injectable fillers are a very big part of my practice. My specialty was among the first doctors to use Botox®, so I have been using Botox® for patients since 1993. For injectable fillers, we actually have a tremendous amount of experience in both the Restylane and Juvederm family of hyaluronic acid fillers. I can give you a perspective on my assessment based on your photos.
We want to first understand the causes by looking at the anatomy. When you have an injectable filler such as Restylane placed, you are trying to improve contour through the placement of volume where there’s a volume deficit. That means the Restylane is adding volume, but it’s not affecting function. In our practice, we do something called Structural Volumizing using a high viscosity, or a thicker filler such as Juvederm Ultra Plus or Juvederm Voluma, placing it into the chin area on top of the bone to improve the projection of the chin, essentially doing what we would typically do in surgery with a chin implant.
As far as the fillers settling, the activity of facial movement does allow for filler to mold, but what you are describing, is an action that is the result of muscle activity. The explanation of a dimple that occurs with muscle movement is the muscle itself. What is responsible for chin dimpling is the mentalis muscle, which is injected routinely with a neurotoxin to relax it and improve chin dimpling. With some movement, you have exaggerated dimpling, so that asymmetry most likely means it’s the activity of the mentalis muscle responsible for this dimpling, which can be solved with more neurotoxin.
The way to think about neurotoxin is to understand the process in which it is first administered, and when it reaches its maximal effectiveness. With Botox®, the initial onset can be in the first 3 days, but the maximal effect is at two weeks after the injection. In our practice, we see our patients after two weeks, and then do enhancement as is appropriate.
More than likely, you’re dealing with a asymmetric effect of the neurotoxin in the chin, specifically in the mentalis muscle, which seems relatively easy to correct. Ask your doctor when they think you should come in. As I said, in my practice, usually it’s two weeks as that’s when we know the peak activity has been achieved, then we can do enhancements from that point. I hope that was helpful, I wish you the best of luck, and thank you for your question.This personalized video answer to your question is posted on RealSelf and on YouTube. To provide you with a personal and expert response, we use the image(s) you submitted on RealSelf in the video, but with respect to your privacy, we only show the body feature in question so you are not personally identifiable. If you prefer not to have your video question visible on YouTube, please contact us.

For unique cases where a variety of modalities could be used to treat the condition, I would suggest an in-person or virtual consultation to develop a custom and effective treatment plan. It is difficult to precisely define the best option without collecting the same information. I suggest reaching out to an expert for a consultation with surgical and non-surgical methods to get a comprehensive option. Best, Dr. Emer.

Thanks for posting your photos. I don't think this is the filler, but i guess it is the Botox. Your muscle in the chin area is just starting to relax and that's to most likely cause of the dimple. Once the entire Mentalis muscle is relaxed, the dimple should cease to exist. See your injector in two weeks for an appropriate diagnosis.