Can botox make the wrinkles 'go elsewhere"? (Photo)

I am 48, and have been getting botox in my forehead and crows feet for several years. I developed these deep lines below where my crows feet would be, down my cheeks. My mom or grandmother did not have them, and I heard of others who developed wrinkles in unusual places. Once read an article about Renee Zellweger getting bunny lines on her nose.

Doctor Answers 7

Botox and Wrinkles around the Eyes

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Botox is a great product to treat the area around the eyes and forehead.  The smile lines that you are describing are as a result of aging and also of losing volume in the mid face.  Other fillers such as Sculptra can help by replacing lost volume or Thermage by tightening the skin around the face.  As we age, other areas become winkled but not all areas can be best treated by Botox.

Wrinkles in Unusual Places

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Botox relaxes the muscles that are injected, not every muscle is injected so you may notice “other” wrinkles more after a Botox treatment. The “deep lines” you refer to are caused by the contraction of your cheek muscles and are formed as a normal aging process. Our facial aging is due to changes in several types of tissue including skin, fat, muscle and bone. As we age we lose elasticity in the skin making our skin more likely to wrinkle or sag, we also lose fat and bone in the cheeks causing noticeable changes in our appearance.

If you would like to improve the “deep lines” you could get filler injected in that area so you do not see the folding of the skin, improving the appearance of the lines. Alternatively, there are also laser treatments that tighten the skin to improve the appearance of those lines. It is best to consult with a Board Certified Dermatologist to see what treatment is best for your concerns.

Nissan Pilest, MD
Irvine Dermatologic Surgeon
4.6 out of 5 stars 23 reviews

Chasing Wrinkles with botox

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You may have a hyper-expressive face. That means that where you don't get Botox you will see lines. That doesn't mean you should get more Botox however.  You may benefit from skin care to recover some of your skin's elasticity. In the long run this may be you best bet. The more you know about Botox and Fillers, the better you can decide what to do.

Manuel M. Pena, MD
Naples Plastic Surgeon

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Not all lines can be treated with Botox

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Thank you for the question and the photo. It seems like this is an issue of treating one area making another area seem worse.  Basically, you can treat the crow's feet safely to flatten the skin around the corner's of the eyes. The lines that you see below that are also caused by muscle movement, but a different group -- the zygomaticus major and minor.  These muscles lift the corner of the mouth when you smile, talk, etc. Botox here is not recommended and would adversely effect your smile.  Lines in this area can sometimes be treated with fillers or laser resurfacing.

Lines down cheek

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The lines extending down the cheek just along the lower crows feet area are caused by the muscles that elevate the the lip with smiling. These muscles are called the zygomaticus muscles which originate in the cheek bone and insert in the upper lip. If these muscles were treated with Botox you would be unable to smile. These lines are not caused by Botox, but they sometimes seem more prominent due to the fact that the crows feet are less prominent with Botox.

Botox and wrinkles "going elsewhere".

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Botox is very effective at relaxing muscle groups being treated.  When those muscle groups are treated effectively, sometimes other surrounding muscles will be "recruited" and therefore other lines may become visible.

Similarly, when some muscle groups are relaxed, other initially less visible/noticeable lines may become more apparent.

Trust your face to an experienced board-certified facial plastic surgeon, dermatologist, or general plastic surgeon.

William Numa, MD, FACS
Boston Facial Plastic Surgeon
5.0 out of 5 stars 7 reviews

Botox changes the muscle dynamics about surrounding area

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Botox can change the muscle dynamics around the treated area and also in the adjacent non treated area.  This can cause lining that extends beyond the treated area.   In all my years of doing Botox I have never seen any significant adjacent area wrinkle  issues but I do not doubt they can occur.   If this does occur usually the adjacent area is not much of a detriment and the patient chooses to continue with their Botox plan.   Bunny lines are very common and I have never seen bunny lines pop up adjacent to frown treatment.   So it comes down to patient choice.  One can always stop Botox for a 6 month or so period and see what the outcome is.  My Best,  Dr C

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.