What has Botox done to me and will my temporalis muscle go back to normal? (Photos)

Question

I received botox treatment 4 months ago 6/4/17 on my head crowsfeet & jaw muscles. I was 4 months past my other botox previous but had lighter units as I hate frozen look this time I received much smaller dose I noticed almost immediately my Temple muscles or crows feet eye muscle a distinctive line or pull to my eye muscle that looked distorted and sunken was told it was just the pull unfortunately and worst case it will wear off as botox is not permanent. Will this ressolve ? Thank you

Ramandeep Sidhu, MD · Answer

Great question and good concern. The lateral part of the eye brow is pulled up and its simply because there is no botox injected in that part of the forehead. options are to let the botox wear out or inject a small amount in the forehead above the lateral part of the eyebrow and that will balance the forehead.

B. Edward O`Dell, MD · Answer

A little Botox above the peak in the frontalis muscle can correct this.  Not too many units though.  Fairly easy fix.
Dr ODell

Alex Eshaghian, MD, PhD · Answer

Thank you for your question and for sharing your
photographs NoseR01. 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 without a
formal exam in the office where I can view the skin in multiple angles and observe
wrinkles formed with facial expression. However, I hope the information provided here is useful.The pivotal studies used 20 units of Botox in
the glabella area between the brow to address the frown lines. 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 used 24 units of Botox (12
units per side) to address the crow’s feet. 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.There have not been such studies published for
the horizontal lines on the upper forehead. However, in my experience I find
that 10-20 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 Botox is used in the upper forehead, if the
dose is too high or the placement is too low it can result in the feeling of
heaviness in the eyebrow or even lower the position of the brow. In order to
reduce the risk of this possibility, I use a conservative dose in the area and
place the product high on the forehead, sometimes near the hair line. Additionally,
I recommend that my patients simultaneously receive a small amount Botox
between the brows and at the corners of the brows. This will relax the muscles
that pull down on the brows to counteract this effect and provide a harmonious
balance to the position of the brow. The results are assessed two weeks after
the treatment. If there is any asymmetry a small amount of Botox can be placed
in the upper face for correction.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.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.Please consult with a doctor for specific
recommendations. Good luck!

Melvin Elson, MD · Answer

Although there was injection of the temporalis and the crows feet areas the frontalis is pulling the eyes up and lateral because no injection was done in the lateral area of the frontalis. injection there would fix this problem

Shaun Patel, MD · Answer

Thanks for sharing your question and photos. The frontalis muscle has not been completely relaxed laterally which is the cause of the pull you are experiencing. A tiny amount of Botox could have been injected into this area to help solve that problem although at this point I would wait for the Botox to wear off which should happen soon. You also have some temporal volume loss which could be improved using a filler such as Sculptra Aesthetic or Restylane.

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What has Botox done to me and will my temporalis muscle go back to normal? (Photos)

Answers (6)

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