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POSTED UNDER Botox REVIEWS

Botox and Hourglass Deformity - Richland, WA

Name: Botox and Hourglass Deformity - Richland, WA
Item: Dr. Esteban Ambrad-Chalela
Rating: 1
Author: Rivergirl37

ORIGINAL POST

I've been using Botox injections to treat my 11's...

Rivergirl37April 17, 2015

$560

I've been using Botox injections to treat my 11's for quite a few years, not regularly, maybe once a year or so. I have some forehead wrinkling also that I've had treated but I don't like the eyelid droop so I tend to avoid that area. The last time I went in was late September last year and since I was going to be going to Hawaii the following month I decided I should get a little in my forehead as well. Then, while I was there, I was talked into having the little wrinkles around the outside of my eyes done, which I'd never done before.

All was fine until I began to notice that my temples started to appear sunken, this was about the time of my Hawaii vacation. By mid-November I was so concerned that I called my regular doctor in a panic thinking I had some sort of brain wasting disorder, and thank goodness I have long bangs to cover that area because I looked seriously ill. I spent quite a bit of time on the internet trying to figure out what could be causing this, I was really scared there was something wrong with me. At some point I realized that this happened after the Botox treatment and that the 2 events might be related.

I finally ran across some literature online that talks about an hourglass deformity caused by temporalis muscle atrophy attributed to Botox. This deformity has only been reported in patients treated with Botox for migraines, not cosmetically, so I was curious how this had happened to me and I tried to contact my Botox doctor, Dr. Ambrad. When I called his office the front desk people said they had never heard of that problem with Botox and they were sure that Botox couldn’t be the cause. They wouldn’t let me talk to the doctor, and instead of having me come in like I requested, they told me to just email them pictures of the problem and said someone would get back to me. I sent the pictures and they called back and said that they didn’t know what caused that but if it was Botox, it must have been because I had some abnormal reaction to it and they assured me it would fade in 3 months. They were very defensive even though I was insisting that I only wanted them to know about this so that I could understand what happened to me and they could prevent it from happening to anyone else.

I requested they send me the pictures on file that they took of me before I had the last Botox treatment and they did. When you compare the before pictures with the picture of my temples from November, you clearly see the difference. Also, my temple deformity looks exactly like the pictures I found from a paper written by Dr. Bahman Guyayron (A Real Self doctor). Note that Dr. Bahman Guyayron was discussing a study to identify migraine trigger points using Botox, and observed that varying degrees of hollowing of the temples occurred in all of the patients treated. A cosmetic patient, so I’ve heard, should never have been injected in the temporal muscle.

I emailed them all of the literature I found about this problem but received no reply. I still don’t know if the doctor who injected me realizes he did anything wrong, or even if he heard that anything happened to me at all, because I wasn’t allowed to speak with him. No one has called me to find out how I’m doing or to see if the situation improved (thankfully it has, somewhat).

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Dr. Esteban Ambrad-Chalela

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I like Dr. Ambrad, I just don't think he knows what he's doing when he's injecting Botox. I'm also disappointed that his front office staff refused to believe that this was a known side-effect documented in multiple medical journals, instead blaming my poor outcome on my own anatomy, and wouldn't allow me to speak with Dr. Ambrad about what happened to me. I'd been a Botox patient with his office for several years before this happened and I had referred people to him.

Replies (31)

AKraway

April 19, 2015

Rivergirl, you and I must have similar DNA. I just responded to another one of your posts and saw this post. I also had Botox injected in forehead and outside my eyes for the first time and noticed hollowing of my temples but didn't know why. Thought it was sudden aging. Now I know what caused it. I also have protruding veins in the same area. Mine was a year and half ago and it hasn't really improved. Any additional information you can share?

Rivergirl37

April 19, 2015

I'm going to try again to see the injecting doctor and see what he's willing to do, hopefully I can get through the front office blockade this time. Now that I'm coming to the realization that this may be permanent I'm also going to get the opinion of my PS about implants. I'm not really interested in fillers because I'll just end up with the same hollowing a year or so from now. I hadn't brought this up during the initial consultation with the PS so it wasn't part of the fee I agreed to previously, at that time I was still really hopeful that the hollows would improve. I do realize that hollowing is a natural thing with aging, but this seriously accelerated that problem and my body doesn't seem to be able to fully rebuild what was lost. I think it makes me look more than just old, it makes me look ill like an AIDs patient. My eyes look hollow to me now also.

Khloe m

April 24, 2015

I have done Botox to myself as I am a dentist and I have treated the crows feet area too with a very small superficial amount of Botox ( dilution 1 cc to 50 units of BTX). I get a great result of the fine squinting lines. I usually do three points that correspond to the fan like effect of the wrinkles and I don't inject medial to the orbital rim) I think what happened to you is that the injections were not superficial enough and maybe an excessive amount was used which created diffusion to the temporalis muscle causing this hollowing effect. It is inexcusable this doctor has not contacted you or followed up with you. He or she is responsible for the communication of the staff and they shouldn't be diagnosing your results and concluding BTX could not have caused this. Clearly it did! And it's totally plausible. I would call back or email them ( better yet get in writing) and ask if the doctor was made of aware of your calls and concerns. Either way, the doctor is wrong. Any doctor injecting BTX should be well versed In head and neck anatomy to understand what took place here. I would also report this doctor to the the office of professional misconduct. It may even constitute misconduct or malpractice due to abandonment. I bet anything if you spoke like that to thesecretary, you would get a lightning fast response from doctor! :))). it is surprising this area has not rebounded after several months post BTX. This may be because there are surrounding muscles in spasm or in imbalance which are pulling on this hollowed area. You may want to consult with a doctor who is well versed in treating migraines with BTX like a pain management doctor or a neurologist or TMJ dentist and who understands the anatomy of this area. Actually any skilled doctor doing BTX should have some insight to your problem. I am so sorry this happened to you, I hope with time it reverts back. Maybe some deep tissue massage and warm compresses in this area will release the pull that's causing the hollow. Thanks for sharing and all the best!!

JA7

April 24, 2015

Just a question please. Did your eyes become hollow underneath as well? I have heard that this can happen if not injected correctly or it can happen from just the use of botox over the years. I no longer can use Botox because it no longer works for me. I get Desport instead. I wonder if lifting it up will help, I guess like a temporal lift??? Please let me know and thank you.

Rivergirl37

April 24, 2015

Thank you so much Khloe, your support means a lot. I did finally get a chance to talk to the doctor on April 21, when I went to pick up copies of all of my medical records from their office for documentation purposes. Interestingly, now that I'm requesting my records they're suddenly interested in seeing me. However, I think their only interest in seeing me at this point was fear based because they are worried I will sue. The doctor still refuses to consider any possibility of fault on his part and continues to claim ignorance in how this could have happened. I'm not a doctor, but I am a researcher by profession and it didn't take me long to collect sufficient evidence to prove to myself what likely happened. I agree that it is inexcusable that he didn't contact me or follow up, and I told him as much when we talked. He admitted that he saw the pictures of me all sunken in and didn't bother to do anything but tell his staff to reassure me that it would go away in 3 months. Unbelievable.

Rivergirl37

April 24, 2015

JA7, turns out the problem I was noticing with my eyes is likely from using Latisse for the past few months, and I've discontinued that. Turns out Latisse contains a prostaglandin and they're finding all sorts of issues with it. There's a 2012 report by Dr. Stanley Berke called "PAP: New Concerns for Prostaglandin Use", you should Google it if you're interested, kind of scary stuff actually. I have not noticed any hollowing underneath my eyes. The Botox side effect was limited to my temples, and now 7 months later it is only slightly better, and my left temple has recovered less than my right. A temporal lift would not fix it, I need volume. I hope that helps.

JA7

April 25, 2015

Yeah some Doctors have NO concern only for the MONEY. Tells you to wait THREE MONTHS !!??. NO! He injecting others in the meantime with no regard that you have to be seen by others, it is YOUR Face, You are upset etc.... If it was his WIFE he would damn well do something. Demand your money back, do not sign a waiver, in fact if he gives you a check, write (Not a waiver ) on it before you cash it. Keep a copy. I have no respect for Doctors that have no concern for patients. Post him on the YELP board in your area and that will cost him. He was disrespectful and had no regard for you so show him no mercy either. I did find that FAT TRANSFER works in that area. Search Fat Transfer on here. Good luck and let us know.

Angie_M

April 23, 2015

Wow, I didn't know that was a possibility either. It's great that you are sharing. Thank you!

JA7

April 25, 2015

Thank You Rivergirl137, Yes I have the hollow under my eyes and that is why I was asking on here, I think to (Graft2958) about (Fat Grafts) She is 57 had the Fat Grafts, but not sure where they put it. She is really cute though and looks 30 years old. I used Latisse for many years, then stopped when extensions came out, then stopped that a started the Latisse again because the extensions were too costly and they charged me full price at the salons even though I was only getting the amount of what they call a FILL. Yes I tried fillers under the eyes, sometimes it was over filled and then that really looks bad, they they have to dissolve it, that hurts worse than fillers and then it looks like DENTS. I had used Botox for 20 years and yes had the temporal problem, but it started years ago, I was just told that AGING was the blame and they put filler in the area. It has cost me THOUSANDS over the years I also think other things like botch previous surgery also made it worse. The face lift I just h helped A LOT, but I will still always need filler in the temporal unless I can get Fat Grafts. I really think that thee PHAM Companies know this LONG before they mention it and that makes me mad. I think some Doctors also know, but just want to make money. We need to start a CLASS ACTION against the makers. I must say that my temples were never as badly dented in as yours. I wonder how it happened ALL THE SUDDEN like that??? That really makes no sense because you would have seen it slowly happening, like I did and then getting worse. I will post if find any answers and you please do the same. I will post photos as soon as I can so everyone can see the new. They are on my camera and I have to have it put on a CD, then load it to my PC then try to figure out how to load it on here. I did hear that BOTOX can cause ALL muscles to Atrophy, just like any muscle NOT BEING USED will...................OMG, What about Our foreheads, crows feet areas etc...????

GreenQueen

November 10, 2015

Free article on Google Scholar: Botulinum toxin therapy: distant effects on neuromuscular transmission and autonomic nervous system. P Girlanda, G Vita, C Nicolosi, S Milone… - Journal of Neurology, 1992.
The other articles showing single fiber EMG do not detect muscle spread are funded by Allergan through doctors/researchers on the consultant payroll. It is amazing that journals will even publish articles written by paid consultants in academia and scientists inside the corporation.
You can buy scientists but you can't buy science and botulinum toxin spreads throughout the body through the central nervous system.

attackmom

November 2, 2015

Wow thanks for this info. Sorry this happened to you.

Rivergirl37

November 7, 2015

Thank you.

whatisbeauty

November 5, 2015

I see a similar reaction in my temples but not to the same extent. It was my firs time with Botox about 6 weeks ago.. I pretty much knew it immediately to be from the botulism. The doctor spoke of eventual atrophy of the forehead like it was a good thing. He didn't mention the temples, even though I expressed concern over hollowing under my eyes and temples. I have discovered Facerobics with Ms Peta on YouTube and it is now my new religion. I don't overdue the atrophied muscles too much yet but I am trying to strengthen up my facial muscles overall.

I hope hourglass shape resolves. I heard there are risks with fat transfer under the eyes , but maybe it's a safer possibility for the temple hollows.

I know it's a pain, but you are beautiful regardless. Beautiful eyes, lovely shaped nose and lips.

Rivergirl37

November 7, 2015

Thank you, that's sweet of you to say. My temples are still not completely normal but my hair covers it most of the time.

whatisbeauty

November 7, 2015

That's good to hear. I have a strategic haircut now too.
I wanted to share something I did. Not sure if it's a coincidence , or maybe boosted my my daily facial exercise (facerobics Ms Peta!) but I got a silk n Face Fx I ordered off Bed Bath Beyond (easier return if it doesn't work) yesterday morning and used it four times yesterday and again this morning followed my major cheek, jaw, chin, eye exercises and for the first time it feels like my left cheek muscle has released a bit. It has been so tight the last 6 weeks.
Maybe it's the red light in combination with the warmth.
Also lymph drainage massage which I think I already said before but just in case , that seemed to expel a lot of garbage from my body.

I am always careful with what I put into my body so am surprised I did this. I just had never heard the horrors of Botox before .

UPDATED FROM Rivergirl37

7 months post

Me, Before and After My Temple Muscles Atrophied

Rivergirl37April 17, 2015

Replies (10)

blonde54

July 8, 2015

OMg I have that same thing going on, I thought I was aging badly and my tissues shrunk but it came out of the blue after botox!

shirley brooks

July 16, 2015

So sorry this happen to you
This might make me reconsider getting botex

rachelgp

September 5, 2015

I just came across your post and I'm shocked!!! I've noticed over the past year and a half my sides look completely sunken. I'd had Botox only in my glabella then a year ago in August I had my forehead done as well. I didn't love those results, so the next time only the glabella was done. Last week I allowed her to do my glabella and forehead (8 units in forehead) prior too injection I mentioned that my outer right muscles above the mid to end of my brow and up seemed atrophied. Sure enough, within 24 hours of her injecting that same muscle went totally dead and the rest of my fave is still movable. I'm convinced a year ago something happened after she injected me- muscle atrophy and the sunken temples!!! Have you had any improvement?!

Merelself

November 8, 2015

I think you should sue for malpractice. Talk to one of those lawyers "who don't get paid unless you do". If he incorrectly injected in the wrong location causing a facial deformity I think you would be entitled to millions.

Merelself

November 8, 2015

Also, no reputable front desk would try to answer a medical question themselves.

sparky47

August 30, 2016

Omg that's terrible. How scary

UPDATED FROM Rivergirl37

7 months post

Pictures 7 Months After Botox, Temples Still Sunken

Rivergirl37April 18, 2015

I always thought Botox was pretty safe, I've used it for around 10 years with no problems. I still think it is safe, IF you are very careful who you allow to treat you with it. The doctor who did this to me is a vascular surgeon, not a PS. That's my fault for thinking someone who was an expert in veins would understand how to use Botox. But I also think it's Allergan's fault for letting practically anyone inject it, if a vascular surgeon can mess it up this bad, they should require that injections only be done by a doctor who is board-certified in dermatology or plastic surgery. And I also blame Allergan for not listing THIS particular side effect as a potential problem after Botox, why wouldn’t this be on the warning along with all the other side effects? Imagine my surprise after all this has happened, finding out that Allergan has very likely been aware of this since at least 2004 but has made no efforts to make any patients aware of it. It should be listed as a potential side effect on all of their patient information, along with headache, ptosis, and everything else that can happen, but it's not there.

I can't post any links to the information I found, but here's a start for anyone interested:

2004
Headache. 2004 Mar;44(3):262-4. Hourglass deformity after botulinum toxin type A injection. Guyuron B1, Rose K, Kriegler JS, Tucker T. Author information Abstract BACKGROUND: Complications, such as eyelid ptosis, have been attributed to botulinum toxin type A. An "hourglass" deformity, which is the consequence of temporalis muscle atrophy, has not been reported previously.

April 2010
Consumer Reports Insights Consumer Reports examines Botox as a remedy for headaches, back pain, tremors Tuesday, April 6, 2010 * * * What are the risks with botulinum toxin? Serious though uncommon reactions have occurred when the toxin has spread from the injection site to other muscles, resulting in general weakness, the need for a respirator and, in rare cases, death. Case studies have described another side effect, also rare: muscles losing their tone from injections around the temple area, resulting in an "hourglass" deformity. Predictable side effects include pain and bruising at the injection site, temporary weakness of the injected muscle, headache, nausea, neck or back pain, dry mouth, and dry or irritated eyes.

July 2012
Anesth Pain Med. 2012 Summer; 2(1): 5–11. Published online Jul 10, 2012. doi: 10.5812/aapm.6286 PMCID: PMC3821109 Beyond Beauty: Onobotulinumtoxin A (BOTOX®) and the Management of Migraine Headaches. Complications of Onobotulinumtoxin A injections to sites I, II and IV although rare, could include eyelid ptosis, hourglass deformity of the temples, and early fatigue during neck extension and diplopia. Hourglass deformity may improve over time, but can be corrected with artificial fillers or fat injections. Apraclonidine 0.5% eye drops may help with eyelid ptosis. Apraclonidine is an 2-adrenergic agonist, which causes Müller muscles to contract quickly elevating the upper eyelid. By minimizing the amount of onobotulinumtoxin A injected to the necessary amount by correct identification of the trigger sites and other maneuvers described above one can minimize these complications.

Replies (10)

VK ugly

April 20, 2015

That happened tI me as well. My forehead and entire face fell. I changed the way I wear my hair, so you can not see deformity.

RealSelfChris

April 21, 2015

Thank you for sharing your experience and knowledge with the community. I'm sorry you're going through this. Please keep us posted on how you're doing.

Afnav

April 21, 2015

Wow, I had know idea something like this was even a risk. I recently had my second Botox treatment and am less than thrilled with the effects myself. Nothing to do with the temples tho. Something you might look into to improve the look of your temples is sculptra injections. My Dr calls the hollowing of the temples peanut head. She injects the sculptra into my temples and the scalp behind my temples and it has greatly improved my look. Best of luck to you!

Casey656

April 21, 2015

Thanks so much for sharing this. I've had it a few times and I think until all these drugs have been around for a lot longer, only then will we really know all the possible side effects to judge if it is right for us. Good luck to you and I hope it's just a matter of getting it all out of your system for those hollows to fill out. You're so pretty and it looks like you can cover it with your hair well.

bigbubbles11

June 25, 2015

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