Two doses of Botox in crows area within 7 weeks- terrible cheek droop - been 5 months (Photo)

Question

Had Botox 11/1/23 and 1/24/24. (7.5 units each time/ eye). Terrible cheek drop happened a week after second dose. It's been 5 months and little to no improvement. Got second opinion and she said zygomaticus affected and 3-6 months (or more bc of "double dose"). Will this go away? Cheek bone area is so flat and cheeks are like balls near nasolabial folds. Dark lines under eyes. No filler in face only lips. Shelving on cheeks and the cheek won't lift past the shelf. Please help

Anna Chacon, MD, FAAD · Answer

I'm sorry to hear about the distressing experience you're having with Botox. Based on the information provided, it seems like you've experienced a complication related to Botox injections, specifically affecting the zygomaticus muscles, which are responsible for lifting the cheeks.

Here are some points to consider and steps to take:

1. **Understanding the Issue**: Botox works by temporarily paralyzing muscles. In your case, it appears that the Botox has affected the zygomaticus muscles, causing a droop in your cheeks. This can result in a flat appearance of the cheekbone area and an accumulation of tissue near the nasolabial folds, contributing to the appearance of dark lines under the eyes.

2. **Duration of Effects**: Botox effects typically last between 3-6 months. However, in cases where higher doses are used or injections are given too close together, the effects can last longer. Since you received two doses within a short period, it might take a bit longer for the effects to completely wear off. Five months is already a significant duration, but some residual effects might still be present.

3. **Potential for Improvement**: The good news is that Botox effects are not permanent. Given more time, the muscle activity should gradually return to normal. While it is concerning that there has been little improvement in five months, it’s still possible that further recovery could occur. Muscular function and appearance often continue to improve even beyond the typical 6-month period.

4. **Follow-up with Specialists**: Continue to follow up with a specialist, preferably a dermatologist or a plastic surgeon with experience in managing Botox complications. They can provide a more detailed assessment and possibly suggest treatments to help improve the appearance and function of the affected areas.

5. **Supportive Treatments**: In some cases, physical therapy or facial exercises might help expedite the return of muscle function. A specialist can guide you on appropriate exercises if they deem it beneficial. Additionally, there are treatments like microcurrent therapy that some practitioners use to stimulate muscle activity.

6. **Cosmetic Options**: While waiting for the effects to wear off, you might consider non-invasive cosmetic treatments to address the appearance of dark lines and sagging. Treatments such as microneedling, laser therapy, or specific skincare regimens might help improve skin texture and appearance.

7. **Mental and Emotional Support**: Experiencing a cosmetic complication can be very distressing. It might be helpful to speak with a counselor or therapist to manage any anxiety or emotional distress related to these changes in your appearance.

8. **Avoid Further Botox**: Until the current issue is fully resolved, avoid any additional Botox treatments in the affected area to prevent exacerbating the problem.

In summary, while the situation is understandably distressing, there is a good chance that the effects will continue to improve with time. Regular follow-up with a specialist and possibly incorporating supportive treatments can also aid in the recovery process.

Kenneth D. Steinsapir, MD · Answer

I am so sorry you are experiencing unwanted facial weakness. Yes, there can be some serious consequences of these treatments. You really need to work with an injector who knows what they are doing. Due to muscle retraining these effects can persist up to a year. There is no real way to speed up the resolution. In the mean time, don’t double down with more bad service. Please wait this out. If you have any filler in the cheek, I would recommend removing that product to reduce the focal fullness of the cheek.

Camille Cash, MD · Answer

I'm sorry to hear of the issues you are having since your Botox treatment.  The effects of Botox are temporary and will resolve gradually over time.  Though Botox effects typically last 3 to 4 months, it can be longer for some.  I've included a video I hope you find helpful.

Two doses of Botox in crows area within 7 weeks- terrible cheek droop - been 5 months (Photo)

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