Thank you for your question.
You submitted your question without a photo.
And you expressed in the details of your question a concern about the effect of Botox® lingering
beyond 6 months.
You state that your forehead has returned in terms of its activity 80-90%.
But you describe that the area around your eyes being injected that your cheeks push
forward as opposed to the way they behaved prior to getting the injections around the
eyes.
And the clinic is not offering you a timescale so you’re looking for some guidance as to
the effect of Botox® for when it will wear off.
Well, I can certainly share with you my experience.
A little bit of background, I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial
plastic and reconstructive surgeon.
I have been in practice in Manhattan and Long Island for over 20 years.
My specialty of oculofacial plastic surgery were amongst the first doctors to use botulinum
toxin.
And so I have been using Botox® for my patients since 1993.
So I can certainly share with you some guidance.
And the use of Botox® in our practice, we use it very extensively.
We do everything from forehead lines, the crow’s feet lines which is what you had
as well as everything from lip lifting and treating vertical lines around the lips, for
chin dimpling.
It’s remarkably versatile.
We do it for lifting the brows.
The number of things that we can do with Botox® as a tool is pretty amazing.
And I am surprised that you perceive it lasting longer than 6 months.
Generally, in our practice, I tell our patients that the average patient comes back about
every 3-4 months.
Very often, it’s because they want a certain level of inactivity or limited activity of
their muscles to be maintained so they don't let it wear off completely.
There is a certain amount of learning about the patient when we first start doing anything
whether it’s an injectable neurotoxin like Botox® or an injectable filler such as hyaluronic
acid filler.
And essentially, I usually see our patients about 2 weeks after the procedure and then
we see them after several months.
And what I do to make a point of is taking photos before the procedures so that I can
document what the facial movements are so that we can compare them.
And there are a lot of reasons for this: one of which of course is to be able to show our
patients the improvement.
But another reason has to do with what the perception of people have of their appearance
regardless of whether it’s the use of a neurotoxin, injectable filler or even surgery.
What I have often seen and I don't want to imply or assume that this is applicable to
you but I think it’s an important thought to have.
There is something about the observer’s bias that I think is important.
And a lot of times people feel that they have certain things after a procedure that they
really have a conviction about not having before the procedure.
And then when I show those photos where they did exist, it’s an opportunity for clarity
to actually have the realization that something was a certain way.
It’s curious that you’re describing a situation where your cheeks are pushing forward.
When you treat the crow’s feet lines which I think is what’s most likely was treated,
what you are affecting is a particular muscle called the orbicularis oculi muscle.
When that muscle is engaged, typically during squinting, that muscle is going to form those
crow’s feet lines.
When the muscle is relaxed, those lines soften.
And with recruitment with that activity or I should say attempted recruitment, when you
have Botox® or any other neurotoxin on board, it doesn't contract as much.
Now that’s to be distinguished from the area becoming compressed and creating the
lines when the cheeks move upward and that’s more of what I call as an accordion effect.
I don't see how the muscle reduction of activity and the crow’s feet area would cause your
cheeks to push forward.
So I would suggest that you would discuss this in a way that if your doctor could show
you the images taken and the way I take these photos, I take the photos without expression
and with expression to help my patients see the dynamics.
I think you might be able to appreciate whether or not there’s a direct relationship.
Usually these neurotoxins wear off.
In fact, it’s actually a challenge to try to stay on top of the rate of the reduction
of activity because it’s always about, at least in my practice, I try to keep my patients
looking natural where they can have reduced activity but still preserve some of their
natural movements so they don't look like they have been, “Botoxed”.
And so I think that in your situation, you can be confident, even though it is lingering
a little bit longer than would be expected that it will wear off.
There has yet to be any awareness as far as I’m aware in my practice of doing this for
so long where a person would have a long-term effect due to the natural pharmacology and
physiology, the Botox® just wears off.
I think it’s important that you maintain this dialogue with your doctors and hopefully,
you had some photos taken beforehand.
But if you were to get a second opinion, I think another physician can simply evaluate
the muscles that are treated and give you some sense of the degree of those muscles
actually working at this point regardless and maybe they can give you some guidance
as to what is any residual effect of Botox® or Botox® has worn off.
So I hope that was helpful, I wish you the best of luck and thank you for your question.