Can over-injection of forehead Botox/Jeuveau/Dysport cause muscle atrophy around eyes?

Question

I read some reports that neurotoxins cause muscle atrophy. Would that be use over several years or can it occur after one incident of overinjection? Thank you.

Carmina Cardenas, MD · Answer

I will talk based on my own experience. 
I turned this year 19 years using Botox diligently every 4-5 months in the forehead, frown and crow’s  feet. Non of the areas I have suffered muscle atrophy which I consider is noticeable or had created a dent or depression or hollowness. I have photos of myself 20 years ago with the same facial features in this 3 particular injection areas, but with the great benefits of the selective fiber muscle paralysis. 
I have patients (my mother, sister, example) who I have put Botox for the same 19 years and no atrophy observed either. 
Be encouraged. 
Dr. Cárdenas

Brandon Richland, MD · Answer

Hello, and thank you for your question. One of the most desirable side effects of neuromodulator injections (with Botox, Daxxify, Dysport, Jeuveau, Xeomin) is controlled muscle relaxation. A minor level of muscle atrophy is to be expected due to the lack of use experienced while the toxin is in effect. In certain areas, like the “jelly roll” under the eye (among other areas), a single time injection with a higher dose of medication could absolutely cause an unintended atrophied response &mdash; where the lower eyelid could droop/pucker. However, due to the nature of neuromodulators, it would be a temporary reaction that would resolve over time as the toxin is metabolized. A more permanent muscle atrophy could also occur but it would likely take many treatments, to the same area, over many years. I would advise that you seek out an experienced injector for future neuromodulator procedures, preferably a provider that will listen to/address your concerns while being transparent/educational about placement and expectations during the consult. Best of luck!

Camille Cash, MD · Answer

Botox and other neuromodulators work by decreasing the ability of a muscle to contract.  The effect is temporary, lasting approximately 3 to 4 months.  Long term, consistent use of the product may lead to some muscle atrophy is some patients.  It would not occur after a single use.

Geeta Yadav, MD · Answer

Thank you for your question! Since neurotoxins limit the activity of the targeted muscle, it is possible to experience temporary muscle atrophy from a neurotoxin appointment. That said, it’s much more common in patients who consistently undergo neurotoxin injections in the same area. Though more lasting atrophy can occur, it is very uncommon and is usually experienced by patients who are consistently treated with excessive doses of neurotoxin at a frequent cadence and over an extended period of time. Be sure to express your concerns to your provider before undergoing treatment. Good luck!

Douglas Taranow, DO, FACOS · Answer

Botox and all neuromodulators paralyze the muscles from moving and of course, cause some degree of atrophy by non use.  With prolonged use, the muscles will atrophy moderately, however, a single treatment should not cause significant atrophy.
Best wishes.
Dr. Taranow

Can over-injection of forehead Botox/Jeuveau/Dysport cause muscle atrophy around eyes?

Answers (5)

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