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Had Botox done on face and face looks totally different. What can be done?

DOCTOR OF THE MONTH - Dec 2013
Dec 2013
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Dermatologist
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Hi,
I had Botox done not quite 6 weeks ago and my whole face looks different. Sunken cheeks, sunken eyes, sunken temples, wrinkly bags under my eyes, made the sunken eyes worse, folds at mouth worse. My face is basically flat ( no volume ) lips smaller. Also , teeth don't come together right and my tmj is acting up. Cheek bone seems to have receded. I don't even look like I did before the Botox. I am so scared! I can't see how any of this is going to get better. Can you help me??? Why is this happening. Thank you, XXXXXX
Posted Wed, 3 Jul 2013 in Beauty
 
 
Answered by Dr. Sanjay Kumar Kanodia 48 minutes later
Hi,

Welcome and thanks for posting your query to XXXXXXX

Myself Dr S K Kanodia and will try to provide you the best of information regarding your query.

I can very well understand your condition and I am really empathetic to the situation.

Now as per your query "botulinum treatment (botox)" was done almost 6 weeks ago. Presently you are feeling the problem of totally different of texture and appearance of your skin face (in negative manner).

To explain your situation, the chemical inside "botox" works to relax the muscles where it is injected. As in yourself, it was used on facial muscles so it relaxed those muscle where it was injected.

In your case I can make out that most of the facial muscles from forehead to eyes and around mouth, the injections were given. After the injections the muscles slowly gets relaxed and the full effects generally takes around 2-3 weeks depending upon the strength of the muscle. This effect is a temporary effect remaining for around 4-5 months with peak effect at around 6-8 weeks of period and then it declines to completely resole in 16-20 weeks.

Along with the above fact it also depends on the units (the amount) of botox given. So if higher than that required amount is given then also there is possibility of kind of look which you have got.

Therefore you can understand now that the kind of sunken looks all over face with other of the changes as you enumerated is because of the full effect of botox treatment.

First and foremost, kindly relax yourself as the effect is totally temporary an will be reducing and vanishing off in next few weeks. As I already mentioned above, this botox treatment is most effective generally for 2-3 months and then recedes to normal in next few weeks.

For yourself it is 6 weeks so it would be taking another around 4-5 weeks to reduce.

You should definitely XXXXXXX your doctor who has injected botox to guide you for certain exercises also to reduce the effect and to counter act the sunken effect of the face.

Hope the informations provided would be helpful to you. If you have any further questions, I will be happy to help.

"Wish you good health"

Regards,
Dr Sanjay Kumar Kanodia
(MD- Dermatology)
Above answer was peer-reviewed by
 
Follow-up: Had Botox done on face and face looks totally different. What can be done? 1 hour later
Hi Dr. Kanodia,
Thank you for your response. Have you ever had a patient with all of these issues from Botox? This is so drastic. Will all the hallowness and volume and cheek bone be restored, too? And why would I have a problem with my teeth and jaw. Do all the muscles get atrophied and how would this be repaired? The doctor has not been of any help. Can you direct me somewhere for excersizes and can I do them before the Botox wears off? Thank you for your empathy! XXXXX
 
 
Answered by Dr. Sanjay Kumar Kanodia 3 hours later
Hello Madam,

Welcome again to the forum and thanks for your prompt reply.

For the first query of yours, yes we do see patients where such kinds of effects are seen. Though these kind of things are very rarely encountered but not very uncommon. In my clinical practice of last 10 years with, I have seen 3 patients with such condition. And on that clinical experience as well as the knowledge from our regular updating, I assure you that if there is no other systemic illness along with this then you would be quite alright in next few weeks.

All the problems of hollowness as well as teeth and jaw related problems occurred just because of extra units of the injection. This happens because botox is water soluble, so it can seepage to nearby tissues and muscles leading to temporary relaxation of the muscles. Therefore you feel all the effects enumerated above. There is no atrophy of muscles at all by the use of botox.

For the exercises, yes you can do some facial exercises such as blowing, whistling and others like inflating balloon. There is no need to any where for these facial exercises. You can also take help of internet quoting “exercises to tone up facial muscles”. One good link I am providing you below:

WWW.WWWW.WW
Along with it can see some videos on you tube for further assistance.

Still if you have any doubts then for further guidance you can visit a good dermatologist near you with ample of experience in botox.

Along with this, as I discussed in my previous Email that these are totally temporary effects, so please kindly reassure yourself from any possibility of permanent side effects.

Hope these informations will help you. If you have further queries I will be happy to help.

"Wish you good health and early recovery from the problem"

Regards,
Dr Sanjay Kumar Kanodia
MD (Dermatology)
Above answer was peer-reviewed by
 
Follow-up: Had Botox done on face and face looks totally different. What can be done? 2 hours later
Dr. Kanodia,
Thank you for your response. What kinds of systemic illnesses would prevent recovery. I have POTS which I know is a problem with the nervousness system. Since, the Botox I am having an increase in symptoms. Would this prevent recovery
? Also, the bone under my eyes (I think it was my cheekbone is not sticking out like it was. What would cause this?
Thank you for answering my questions.
XXXXX
 
 
Answered by Dr. Sanjay Kumar Kanodia 14 hours later
Hello Madam,

Welcome and thanks for asking further queries.

The systemic illnesses which can hamper with recovery are common causes like hypersensitivity to botox and certain neuromuscular diseases. If I am getting it right, you have written that you have “POTS” which I can make out as Pott’s spine - the tuberculosis of vertebra.

In your case I can indirectly correlate your pott’s spine problem. It means it is not directly affecting botox treatment but indirectly by certain medications given for the treatment of Pott’s. There are certain medications such as amino-glycoside antibiotics or certain anticholinergics which can enhance the effect of botox. So if you are on any of the medications for pott’s problem then it can interfere with botox.

For the problem of cheek bone- as already mentioned is just because of the relaxed muscle. The tone of the muscle over cheek bone gives the effect of fullness and contour. So if the tone is not proper then it leads to the effect which you are feeling.

As I can get you are quite stressed regarding your problem, so still if you have any doubts then you can visit a good dermatologist near you with ample of experience in botox for further guidance.

Lastly I agin reassure you that these are totally temporary effects, so please kindly reassure yourself from any possibility of permanent side effects.

Hope these informations will help you. If you have further queries I will be happy to help.

"Wish you good health and early recovery from the problem"

Regards,
Dr Sanjay Kumar Kanodia
MD (Dermatology)
Above answer was peer-reviewed by
 
Follow-up: Had Botox done on face and face looks totally different. What can be done? 3 hours later
Hi Dr. Kanodia,
I have a condition called Postural Orthostatic Tachycardia syndrome not tuberculosis of the spine. Are you familiar with this? How would I know if I am hypersensitive and could my condition cause problems with recovery? I turned to you because my dermatologist denied this being from the Botox. He was the one that gave me the Botox. So, I really need your support and I appreciate your knowledge about my situation.
Also, do you think at this point I should not be seeing anymore negative reactions from the Botox.
XXXXX
 
 
Answered by Dr. Sanjay Kumar Kanodia 8 hours later
Hello Madam,

Welcome again to the forum and thanks for your prompt reply.

For the problem of Postural Orthostatic Tachycardia syndrome or in short form POTS has a symptom of weakness of muscles along with all the main cardiac symptoms and/ or other of the symptoms you may be feeling. So, because of weakness in muscles or to say medically as problem in "neuromuscular junction" in this disease, the problem may get aggravated by certain compounds and chemicals which relaxes the muscle.

There fore most possibly now we can get a valid reason of your muscle weakness and can correlate the whole sequence of events.

As I mentioned that the effect of botox is at its peak by 6-8 weeks and remains for maximum of 4-5 months, so I don't think that it would be further aggravating after that time. Even then, as you have this systemic problem so I request you to at-least see your doctor who is treating this "POTS" problem and explain him/her your situation for further suggestions and guidance.

I request you to be careful next time if you are going even if for any simple procedure. Do tell your doctor that you have the problem of Postural Orthostatic Tachycardia syndrome so that any other problem can be taken care of accordingly.

Hope these informations will help you. If you have further queries I will be happy to help.

"I wholeheartedly pray for your good health and early recovery from the problem"

With best regards,

Dr Sanjay Kumar Kanodia
MD (Dermatology)
Above answer was peer-reviewed by
 
Follow-up: Had Botox done on face and face looks totally different. What can be done? 4 hours later
Hi Dr.Kanodia,
So, what you are saying is that my face will go back to normal,after the Botox wears off even though I have POTS? I did inform the doctor that did the Botox, but he did not advise not to do it? I had done Botox twice before with a different doctor. He said he is very conservative with the amount he uses. So, it may be that it was a combination of POTS and amount given?
Thank you for your understanding and knowledge of this situation. I could not get any answers from doctors here. Also, thank you for caring! XXXXX
 
 
Answered by Dr. Sanjay Kumar Kanodia 3 hours later
Dear Madam,

Welcome and thanks for your further queries.

I can very well understand and feel that you are deeply worried about the situation you are facing.

You have to understand that human body is peculiar in itself. It behaves differently in different individual for same thing and even in same individual sometimes we find different responses to the same thing we used. So in your condition also, based on the facts provided by you I have provided the closest possibility and then related guidance according to it.

Here with this forum, we have the limitation that we can not see or examine the patient lively or in person. Because of this limitation our guidance is limited to a particular extent.

If the local doctors at your place are not helping you out then it is best to consult at Medical College level. I can make out that you are from Lancaster, so you can either visit Medical College at Philadelphia/ Pennsylvania. At Medical College level a multidisciplinary approach can be made by different departments and highly specialized doctors.
By full examination and by proper team approach the best diagnosis can be made regarding your situation and treatment can be provided to you. I think this should be your final line of action on immediate basis to resolve the deep trouble you are facing.

I hope you find these informations helpful to you. If you have further queries I will be happy to help.

"I sincerely wish for your strength and determination in earliest recovery from the problem."

With best regards,

Dr Sanjay Kumar Kanodia
MD (Dermatology)
Above answer was peer-reviewed by
 
Follow-up: Had Botox done on face and face looks totally different. What can be done? 4 hours later
Dr. Kanodiia,
I am so confused? So, now you are saying you don't know if this is going to resolve at all? Now I went from hopeful to discouraged. I thought in your last response that you still thought that my muscles would regain strength after 4-5 months?
Another complicating factor is that I don't have any medical insurance right now. Do I need to get immediate attention with this condition?
Thank you,
XXXXX
 
 
Answered by Dr. Sanjay Kumar Kanodia 2 hours later
Dear XXXXX

First and foremost please discard the gloomy possibilities from your mind.

Let me clarify again that the problem you reported is temporary one and not permanent. In none of our discussion did I say that you will live with this problem permanently. Botox effects would be reducing and resolving in next few weeks period like in all the other patients we see in our day to day practice.

However the only issue is that "Postural Orthostatic Tachycardia Syndrome" (POTS) can hamper early course of resolution or the normal course of resolution. Therefore without an opportunity to examine you in person, it would be extremely difficult for me to predict the course of resolution / duration of resolution.

Because of this above reason as well as the reason of no help from the local doctors I requested you to reach the highest level of guidance i.e. at Medical College / University level. At Medical University we find the best approach to the problem with least costs.

Lastly I again reassure you that your kind of problem is not unusual or kind of acute emergency. The temporary effect of botox definitely resolves completely in 4-5 months.

Hope things are clear and bright now.

Wish you good health and early recovery

Best regards,

Dr Sanjay Kumar Kanodia
MD (Dermatology)
Above answer was peer-reviewed by
 
Follow-up: Had Botox done on face and face looks totally different. What can be done? 13 hours later
Hi Dr. Kanodia,
Thank you for your patience with me trying to understand. I really appreciate your help and guidance. Can I request you if I have any questions in the future?
XXXXX
 
 
Answered by Dr. Sanjay Kumar Kanodia 6 hours later
Hello Madam,

Most welcome to the forum again.

Thank you so much for your appreciation. Your appreciation is a source of inspiration for us to provide the best guidance. We are dedicated to give the best suggestions at our forum.

You are heartily welcome at our forum for any kind of health related issues i future also.

"May God bless you"

Best regards,

Dr Sanjay Kumar Kanodia
MD (Dermatology)
Above answer was peer-reviewed by
 
Follow-up: Had Botox done on face and face looks totally different. What can be done? 3 days later
Hi Dr. Kanodia, There was one factor I didn't include in my discussion. I guess I didn't say anything because it sounds strange and I think most doctors don't think it can happen. I have been feeling ill since I had the Botox I have been having all kinds if horrible symptoms: dry mouth, dry irritated eyes, horrible anxiety, tinnitus, my hearing seems a little muffled, sometimes my food feels like it is hard to swallow, numbness and tingling in my arms and hands, dizziness, etc. and I feel like I have been hit by a truck. I had the Botox in my frown lines and crows feet, but it must be effecting my jaw as well, because of the tmj and teeth problem. I'm really not sure what to do? I don't know if this happened because of the POTS or not? Does this change the outcome of my sunken facial problems? My eyes feel locked in ace and they are so much smaller. These facial symptoms have gotten worse over the last few weeks. Thanks again, XXXXX
 
 
Answered by Dr. Sanjay Kumar Kanodia 4 hours later
Respected Madam,

Welcome and thanks for your query.

The latest of the symptoms you enumerated “dry mouth, dry irritated eyes, kind of horrible anxiety, tinnitus, numbness and tingling, dizziness etc., since the Botox procedure are related to the “acute anxiety state”.

This is a frequent out come towards any apprehension in our mind. Day by day as the facial problem increased, you must have had felt more and more aggravation of the symptoms because of increase in anxiety related to the problem. This severe anxiety itself can aggravate the problem of POTS also. So even if this is related to POTS or not one thing can aggravate the other.

Therefore kindly reassure yourself. It is also a common phenomenon in everybody’s life that once we are anxious about one thing then that thing revolves in our mind continuously and then begins the “severe anxiety” leading to all the symptoms you enumerated.

Your problem will take multiple of weeks of period to improve. So kindly make your mind set accordingly. Don’t sit alone. Keep a good company who can give positive suggestions. Keep yourself busy in something. Don’t try to think in this matter even during sleep time also; because that is the time when we think a lot regarding any issues.

As I stated before the only issue is that of “Postural Orthostatic Tachycardia Syndrome" (POTS). This problem can hamper early course of resolution or the normal course of resolution. Therefore all the effects of Botox may be actually modified. Along with this the anxiety of the condition is actually making the things more aggravated.

Kindly reassure yourself and give positive suggestions to relieve yourself from this acute anxiety state.

Hope things are clear now.

Wish you good health and early recovery

Best regards,

Dr Sanjay Kumar Kanodia
MD (Dermatology)
Above answer was peer-reviewed by
 
Follow-up: Had Botox done on face and face looks totally different. What can be done? 35 hours later
Hi Dr. Kanodia,

Thank you for your reply. Can the anxiety symptoms make you feel Totally horrible?Why would muscles in my face / head that weren't injected be effected by the Botox? I feel like the muscles keep getting worse. My eye muscles really feel weak. Will they get any stronger when the Botox wears off? Does it just take more time to get better because of POTS or do I need to be doing something special? Will facial excersizes and or physical therapy help rebuild my facial muscles even with POTS? I really want my face back again!
Thanks for your guidance.
XXXXX
 
 
Answered by Dr. Sanjay Kumar Kanodia 15 hours later
Dear Madam,

Welcome again to the forum and thanks for asking further follow up.

Taking your queries on by one:

1. Anxiety of anything on higher side is such a thing which can actually make any condition worsened. You can compare it with the example that we have seen patients with simple chest pain in anxiety appears exactly as heart attack!!
So probably you can get that the impact of anxiety in real sense is very bad. Therefore I personally and humbly request you to reduce your stress of any kind and do the measures enumerated in my previous Email.

2. Regarding your second query of that why muscles where Botox was not injected are also affected- It could be possible due already mentioned reason of Botox being water soluble, so it can seepage to nearby tissues and muscles leading to temporary relaxation of the muscles. Therefore you can feel all the effects detailed throughout the discussion. There is no possibility of atrophy of muscles at all by the use of botox. This could also be super-added by the fact of POTS in your case.

3. For the third question of regaining the strength and tone of muscles: The effect of Botox totally is a temporary remaining for around 4-5 months with peak effect at around 6-8 weeks of period and then declining completely in almost 16-20 weeks. So you would start feeling the effect of normal tone after that time only. Along with this we should not forget that this can be modified by the effect of POTS in your case which can alter the normal course of recovery for some time but not permanently.

4. For the fourth query of yours regarding exercises for facial muscles: As I discussed it before, simple exercises do tone up the muscles and are always helpful in regaining the normal strength of muscle. For the exercises, I detailed it in previous 2nd Email that you can do facial exercises such as blowing, whistling and others like inflating balloon. I had also provided with a link which I am again specifying below
WWW.WWWW.WW
Lastly with Botox we have never ever seen any permanent atrophy of anything including muscles in Medical sciences. Though as said earlier the POTS may modify the normal course and the effect of botox for sometime but not permanently. In between, as I said previously if you feel it is always better to take second and highest opinion from an Institute at Medical College level.

I can very well understand your point of apprehension also which would be continuing till the time you regain your original face. Now you are in 7th week since your Botox session, so you have to have patience till minimum of 20th week to regain your original status.

Hope I have answered your query and the things are totally clear now. If you have any further questions, I will be happy to help or if you do not have any clarifications, you can close the discussion and rate the answer.

Wish you good health.

Regards,
Dr Sanjay Kumar Kanodia
(MD- Dermatology & STD)
Above answer was peer-reviewed by
 
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