Significant Indentations from Botox Migraine Treatment?

The effects of BOTOX are not permanent.  If the BOTOX was effective in controlling the migraines, you may just have to put up with this appearance.  BOTOX for migraines is chosen when other treatments have not been effective.  If you elect not to have more BOTOX treatment, I would expect this muscle atrophy change to be resolved 6 to 8 months after your last BOTOX treatment.  I would recommend discussing this issue with your injecting neurologist to decide if this side effect is so objectionable that you will not be retreated with BOTOX.

The temporal issue of noting your linear depression three weeks after Botox should not allow us to quickly dismiss the Botox treatment as a cause, but the Botox itself is not known to cause a depression.  So if not the Botox, what could this be?

1. Was there steroid in the injection which got carried off in a vein and caused subcutaneous atrophy so quickly? That has been observed by doctors.

2. Had there been a large vein in the area that had normally provided subcutaneous volume and support to those tissues but the vein somehow went into spasm and is now clotted off leaving a void? I have never seen, nor heard of a botox injection causing this but sclerosants of leg veins can.

3. Would you have developed such a fast onset of localized morphea, "en coup de Sabre" ( the slash of a saber), I doubt it, but a work up by a rheumatologist or dermatologist would be worthwhile.

You should speak to your doctor to see exactly what was injected. Possibly a scan such as a CT with enhancement or MRA may help, but discuss the risks and costs in detail with your doctors before having such.

The spot you have developed may be linear Morphea and not related to the Botox at all.  Go see a good Dermatologist who can help you make the correct diagnosis and get the right treatment.

Botox should not cause a depression of this sort. It looks like a progressive fat wasting condition called coup de sabre.  Like a knife scar to the face.  If this is the case it can sometimes this can be treated with fat injection.

Dear wikit626, the type of marked atrophy of the full thickness of the skin, shown in the picture, is extremely unlikely to be caused by botox. Your dermatologist can best diagnose the exact cause. To me, it looks like either localized scleroderma, or "post-steroid atrophy". There are a few cases in the medical literature , where the simple act of a needle stick in the muscle was followed by localized scleroderma. No cases have been reported following Botox injections , as far as I know.