Deep wrinkles in cheek after Botox to freeze crows feet, what happened?

Question

what has happened? I had filler 2 wks prior in the outer cheek area on the arch. Then botox to open the heavy eyelid and to reduce the dip in malar/festoon area. I now have deep wrinkles when smiling, which are worse than before. I'm hoping it will wear off, or do I get more filler in the dip area.

Alex Eshaghian, MD, PhD · Answer

Thank you for your question calum. I understand your concern. Botox
is a purified protein used to address wrinkles associated with facial
expression such as the crows feet seen around the eyes when one smiles. It is difficult to make an assessment without photographs. However in some people the muscle that is relaxed using Botox for the crow's feet holds up the cheek fat pad. When it becomes relaxed the fat pad sinks and hollowing may be seen under the eyes. Filler can be placed in these areas to restore lost volume. Results from Botox wear of after 3-4 months. 
Please consult with a doctor for specific recommendations. Good luck!

Mohammad Almohideb, MD · Answer

Accentuated muscle activity with Botox might be a contributing factor. Checking the before treatment photos is important to see if you had these wrinkles prior to Botox. Our brain perception of wrinkles changes from noticing attenuated wrinkles in Botoxed areas towards more visible wrinkles in non treated areas.
Good luck

Melvin Elson, MD · Answer

When some muscles are weakened with Botox others may begin to show activity and this is accentuated when filler is added. This will completely disappear but you may want to be sure you are seeing a very experienced dermatologist

Drew Varano, MD · Answer

The wrinkles only happen when you smile . This is because the Botox paralyzed the orbital oculi muscles and you are now getting recruitment of other facial muscles when making facial expressions. Do not treat with additional fillers , it will wear off in 3-4 months when the Botox wears off.

Tracy Evans, MD, FAAD · Answer

This question is very hard to answer without photos.  It would be very helpful to see what you are talking about.  I would say this - filler takes 1-2 weeks to set and then Botox takes about 2 weeks to take full effect.  Wait a few weeks after the treatment before you judge the final results.  Also, remember filler is designed to fill a space and bring back volume while botox is designed to weaken muscles.  The combination could potentially create new lines, but be patient first.  Also remember, it will wear off in about 3-4 months and the filler will slowly go down over time.  After a few weeks, schedule a follow-up with the provider who originally treated you.

Deep wrinkles in cheek after Botox to freeze crows feet, what happened?

Answers (5)

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