What has Botox done to me? (Photos)

Question

Can someone tell me what has happened here? My forehead looks more like a Klingon than a Spocking issue. Is the fixable? I had Botox last week and it’s looking very strange. I’ve had spocking before from this dr but I’m not sure if this is the same issue.

Monica Boen, MD · Answer

Thank you for your question and I understand your concern. While Botox is one of the most frequently performed procedures today, it does require a degree of expertise and experience to achieve the best possible results. In your case, your injector addressed the middle muscles of your forehead while ignoring the opposing muscles to the side. This resulted in those muscles working harder and the “klingon” look you are experiencing. You need additional Botox injections to balance the muscle activity to create a natural look. Make sure you work with a board-certified dermatologist who is also an expert Botox injector to ensure an optimal outcome.

Elliot M. Heller, MD · Answer

Thank You for your question.  Sometimes after receiving botox injections, even up to two weeks, the skin can sometimes look bumpy along with redness.  This should subside and if then you are unhappy with the result, perhaps you can return to the provider.Good LuckDr. Elliot Heller

David Yew, MD · Answer

It appears your provider only injected the middle muscles (procerus and medial insertion points of the corrugators).   Most experienced injectors inject both the medial and lateral heads of the corrugators.
When the lateral portions of the corrugator muscles are not injected - you will see the "Klingon" look from the muscles as well as the "Angry Bird" look because your eyebrows will pull down more than usual.  
If your injector missed the lateral corrugators on your initial treatment - I would consider going to a more experienced provider for correction.   The reason is that if the provider is not experienced and goes to0 far laterally or injects too deep - you may end up with bigger problems like an eyelid droop.

Carmen A. Traywick, MD, FAAD · Answer

Botox lock the release of a chemical called acetylcholine, which triggers the muscle contractions that create wrinkles. Botox essentially paralyze the muscles and stops them from contracting. Results from these treatments are visible within 3-14 days with results that can last anywhere from 3-4 months. Follow up with your injector to discuss your concerns. It is an easy fix. Hope this helps.

Austin Cosmetic Surgery · Answer

Botox relaxes muscles thus allowing opposing muscles to pull harder. If the spread and balance of the treatment is not even you get exaggerated muscle pull that leads to spooking of brows, or more pronounced muscle show as in the “Klingon” look you are referring too. It would appear you possible need further treatment to better balance the muscle dynamic you currently have. Always make sure to wait about 10-14 days though for the full botox treatment to take effect.

Alex Eshaghian, MD, PhD · Answer

Thank you for your question and for sharing your photographs mayalea. 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 in the absence of consistent photographs before and after in the same lighting and angles for comparison and without knowing the dose used and the exact placement of the product. However, I hope the information provided here is useful.When patients present with concerns about specific wrinkles in the upper face such as the frown lines, I always assess and usually treat the other wrinkles in the upper face including the horizontal forehead wrinkles and crow’s feet. The reason is to maintain a harmonious and natural balance to the appearance of the upper face. The muscles in the glabella which are responsible for the formation of the frown lines serve to pull down on the inner brows when a person frowns. Similarly, the muscles around the eyes which are responsible for the formation of the crow’s feet seen when smiling (orbicularis oculi) are also responsible for pulling down on the brows, but in this case the outer brows. On the other hand, the muscle in the upper forehead which is responsible for the formation of the horizontal forehead wrinkles when a person raises the brows (frontalis) serves to pull the brows upward. If one of these muscles is relaxed with Botox and the others are not, the other muscles will still be active. This will lead to an unbalanced and unnatural appearance of the upper face where the brow can be elevated, depressed, or uneven in shape or position. Therefore, I recommend that my patients take a global approach to the upper face when receiving Botox treatments and treat all three of these areas. Sometimes bunny lines on the bridge of the nose are also treated.
If I had a patient with the concern described here I would want to see consistent before and after photographs and know the dose and placement of the product. I would recommend that the patient return to the injector for an assessment. The concern can likely be corrected with additional units.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.
  
After a Botox treatment, I recommend that my patients avoid heat exposure, alcohol consumption, and strenuous exercise for 24 hours and not lie down flat for four hours. This is because all of these activities may possibly lead to the movement of the product and consequent side effects such as droopy eyelids. Although there have been no definitive studies shown that these actually occur and some physicians do not provide such aftercare instructions, in the absence of data I err on the side of caution and recommend that my patients avoid such activities.
  
Please consult with a doctor for specific recommendations. Good luck!

Jean M. Casello, MD · Answer

It is difficult to say exactly what is going on from your photos.  It would seem that the placement and/or the dosing of the botox needs to be adjusted.  You should call your injector and have them re-evaluate what is going on. It should be possible to smooth things out a bit otherwise you will need to wait until the botox wears off in 3-4 months. Your injector should be made aware of this so that at your next dosing this issue can be avoided.

Melvin Elson, MD · Answer

The Botox was  not injected throughout the entire forehead so return for another injection session into the muscles that are seen when you look up and that should correct the issue

Niro Sivathasan, MBBS, MRCS, DU (Plast), FAACS · Answer

Your cropped images (and failure to mention the timeframe) limit the assessment that one may provide; however, it is likely that there's an imbalance in the amount of botulinum toxin (BoNT-A) that has been given in the different areas above your eyebrows. Remember that BoNT-A is a paralytic agent, ergo it causes the forehead muscles to drop, meaning it is probable that you need more BoNT-A towards the 'outer' parts of your forehead. Having said that, as a rule-of-thumb, don't draw any conclusions for at least two weeks after the treatment, as it may sometimes require that period of time for the full effect to become visible.

Sagar Patel, MD · Answer

It seems like too much was injected medially and not enough laterally. After it has been 7-10 days return to your injector to even things up. It is really difficult to tell what is going on in the photos since you have cropped them. Bottom line: go back to the person who did the injections.

What has Botox done to me? (Photos)

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