Bump in Chin Two Weeks After Botox, should I wait it out or see my doctor?

Question

I am a 22 year old who had botox treatment 17 days ago for my very pebbly chin. After about 4 days, I started to feel the effects. The bumpy appearance is beginning to disappear but I am unable to move my lower lip downwards and speaking and smiling have become difficult. I was okay with this result until today, when the middle of my chin suddenly contracted creating a significant bump and feeling of discomfort. Was the botox injected incorrectly? Do I need more, or should I wait it out? Thanks!

Aldo Guerra, MD · Answer

Hi Lex. I appreciate your concerns. Chin injections should always be performed with great care so as not to relax the lips. Even when with precision, some Botox can migrate to unwanted areas. I suggest you see your injector to evaluate your chin now. It’s been plenty of time for you to follow up.Good luck! Dr. Aldo

Monika Soni, MD · Answer

Thank you for your question. What you are experiencing is probably caused by the Botox diffusing to closely to the lip, which has affected the muscle that pulls it down, ultimately causing it to pull up. I recommend having a follow up with your injector to address this. Best of Luck!

Alex Eshaghian, MD, PhD · Answer

Thank you for your question lex554. 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.While Botox is most commonly used in the upper face, it can also be used in various areas in the
lower face. Botox can be placed in the mentalis muscle on the chin to address a cobblestone appearance or dimpling on the chin. In this area 2-8 units of Botox are used. A phenomenon seen with Botox is called muscle
recruitment and compensation. When a muscle has been relaxed with Botox,
sometimes other muscles are recruited (or other parts of the same muscle which were not initially very active) and contract when one attempts to make
the facial expression. This serves to compensate for the inability of the
primary muscle to contract. A common example is the bunny lines (caused by
contraction of the nasalis muscle) that are seen on the sides of the upper nose
after treatment with Botox in the glabella or for the crow's feet. Since the
muscles in the treated area are relaxed, the nasalis muscle contracts in an
attempt to compensate for this loss when one frowns or smiles. In such a
situation, the bunny lines can be treated with a small amount of Botox (2-4
units per side). In the lower face, compensatory recruitment can occur when the
platysma muscle in the neck contracts after muscles in the lower face have been
relaxed with Botox. Similarly, this muscle can be relaxed with Botox as well.
For my patients, I usually use approximately 10 units per band. If placed
properly it does not affect other muscles. Relaxing the platysma muscle may
also lead to an improvement of jowls and jawline definition. When such
recruitment occurs, I recommend prophylactic (preventive) treatment of the
recruited muscles at the next treatment.Other areas in the lower face where Botox can be used are as follows: The nasalis muscle on the bridge of the nose is responsible for the
bunny lines that are sometimes seen there when one frowns or smiles. Usually
2-4 units of Botox are used per side for this area. Botox can be placed in the
orbicularis oris muscle around the lips to provide a pout to the lips and
reduce the appearance of vertical lines around the lips sometimes called
smoker’s lines (although they are seen in people who do not smoke as well). In
this area 2-4 units are used above the upper lip and 2 units are used on the
lower lip. Botox can be placed in the depressor anguli oris (DAO) muscle to elevate
downturned corners of the mouth which sometimes produce a sad face appearance.
In this area 2-4 units are used per side. Botox can be placed in the masseter
muscle in the lower face to contour the lower face and address pain associated
with TMJ. In this area 20-40 units of Botox are used per side. Botox can be
placed in the levator labii superioris alequae nasii (LLSAN) muscle located
just beside the nose on either side to address what is called the gummy smile.
The gummy smile is seen in some people whose upper lip elevates so high when
they smile that the upper gums are seen in addition to their upper teeth. In
this area 2-4 units are used per side. Botox can be placed in a vestigial
muscle (seen in some people) called the depressor septi nasii to prevent the
tip of the nose from moving downward when smiling. Here only 1-2 units is
required. Botox can be placed just under the jawline in what is called the
Nefertiti lift to relax the platysma muscle which pulls down on the lower face,
thereby improving jawline definition. When placed lower in the neck Botox can
address vertical neck bands. Approximately 10 units are used below each jaw and
in each band.In the lower face, the depressor labii
inferioris (DLI) muscle sits between the mentalis and the depressor anguli oris
(DAO) muscles. The DLI muscle is responsible for pulling down the lower lip and
it is used when one smiles. If Botox spreads from either the DAO or mentalis to
the DLI and relaxes the DLI it can lead to the appearance of an asymmetric
smile. Some physicians try to correct it by placing Botox into the
contralateral DLI muscle (on the other side). However, I recommend that my
patients just wait as the effects go away on their own. This side effect
resolves on its own in 2 weeks to 4 months, depending on the severity.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 as described above. 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!

Satyen Undavia, MD · Answer

Thanks for your question. If the botox is injected in the correct muscle, it should not effect your smile. The bump you are seeing is either residual muscle function or a bruise (less likely). There is no way to reverse the botox, but you might want to show the injector so they have an idea of how you reacted to the injection and maybe change the injection site next time. Good luck!

Jean M. Casello, MD · Answer

It is difficult to advise you without photos.  You should not have difficulty moving your lips or smiling after botox injections into the chin.  It is possible that the botox migrated to other muscles resulting in the difficulties you are having now.  You should follow up with your physician to discuss these issues.

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