Thank you for your question! You state in your question that you had a
massage where approximately 5 days after you had Botox™ injection where you couldn’t
move your forehead and after this massage, you state that you have full movement of your
forehead and you appear to have a dent in your forehead and you have a scheduled appointment
with the person who injected your Botox™ in about a week. So you are asking about did
the massage ruin your Botox™. Well I can give you my perspective as a practicing
doctor. I’m a board certified cosmetic surgeon and fellowship trained oculofacial plastic
surgeon practicing in Manhattan and Long Island for over 20 years. In fact botulinum or Botox™
was actually something I have been using for patients since 1993 and our specialty of oculofacial
plastic surgery, we are actually amongst the first few doctors to actually use Botox™
in medical conditions such as benign essential blepharospasm and so since then, I have been
using Botox™ pretty much every day. So just as a review to understand how Botox™
works. Botox™ is referred to us neurotoxin. Botox™, Dysport, Xeomin, they are all different
versions of A botulinum toxin and so this works by actually attaching to receptors in
the muscle and there is a point to this. When the Botox™ does bind the receptor, that
muscle is effectively relaxed or paralyzed depending on the number of receptors that
are affected. Now that being said, when we do Botox™ injection in our practice, I explain
to patients that the onset of the benefit, you can begin to start noticing things as
early as one day but it’s typically three days and the peak of its effect which has
been confirmed in our medical literature is about two weeks. We see our patents routinely
in about two weeks just to see how things look and to do any enhancements if appropriate.
The point is that, when physiologically speaking, it doesn’t quite stand to reason that a
massage would negatively impact the pharmacological or medical effect of botulinum toxin. Now
there is infrequent group of patients or small group of patients I should say, who actually
develop a resistance to botulinum toxin and will develop a tolerance. In other words,
their body can actually make antibodies to the Botox™ or Dysport, Xeomin and actually
prevent it from working. This is often scene in people who often use it for a long time
but it is still relatively rare. So I’m not going to say that’s the situation with
you. As far as the cause of an indentation in your
forehead, a lot of times when a person’s forehead muscle, the frontalis muscle, when
we talk about Botox™ in the forehead, we are relaxing the muscle that elevates the
eyebrows and that muscle is called the frontalis muscle. When the muscle is more relaxed, it
is possible to see the underlying structure sometimes in patients especially if the skin
is relatively thin of the actual contour of the skull. So there are certainly some questions
that remain to be resolved and in the absence of a photo, I can’t really speculate that
much further but as far as a physical massage, I can just tell you that when we refer using
Botox™ and we use it for medical patients, we would actually go room to room and inject
patients and have them leave and not do any kind of special after care/ When Botox™
is used for cosmetic reasons, kind of the passage of information between doctors fell
into one of two camps. One camp would say, “Don’t move, don’t do anything, don’t
even lay on your face.” And the other camp would say, “Move the areas a lot so that
it will really work.” From my experience and this is over 20 years
injecting patients of Botox™, I think that once the drug is delivered into the muscle,
it will do what it is supposed to do. It rarely has an effect in adjacent area or spreads
to other areas of the body and so I would say at 5 days, you are probably in a fairly
safe zone. Again in our practice, we get to know our patients very well and we get to
see them in a regular basis and so I get to know what the right dosage is and what the
right locations are that create the effect that my patients like. Hopefully, you are
doing the same with your doctor so that your doctor knows your face and knows what’s
unusual and what is normal. So if there is a true indentation, you may want to evaluate
what the cause can be but it’s not likely it is Botox™. As far as the return of movement
and in this time frame, it also makes me question whether or not the dosage was at the level
that would be most effective for you or maybe it’s worth trying a little bit more another
injection just to see if you get that movement relaxed the way you like it.
So once again, I don’t think the massage has had a negative effect on the or pharmacological
effect to the Botox™ but I think that meeting with your doctor about your results and looking
back at your own history will probably of some value in addition to a physical exam.
So I hope that was helpful, I wish you the best of luck and thank you for your question!