Thank you for your question. It's been about three days since you got Botox injected into
your chin and you're describing swelling that you say is like fish capsules were placed
in your chin and you want to know whether or not it will go away and your doctor even
suggested doing additional Botox.
Well, I think that this is something that requires a little bit more physical examination
in order to get a full sense of what's going on. But I can tell you a little bit of what
I believe is likely to be the case in this situation.
Just a little bit of background, I’m a Board-certified cosmetic surgeon and Fellowship-trained oculoplastic
and reconstructive surgeon, and as a foundation, oculoplastic surgeons were one of the first
doctors to use Botox before it became so popular, because it was a drug used mainly for medical
conditions such as benign essential blepharospasm and hemifacial spasm, and I've been using
this drug for patients since 1993.
So I would speculate that there may be some fluid under the skin related to the application
In terms of volume of fluid. To understand what I'm saying, basically botulinum toxin
or Dysport, Xeomin all comes in powder form, and based on the physician’s preferred method,
they can put a certain amount of fluid and then calculate the number of units per volume
of fluid.
In my practice, I generally try to put in as little fluid as possible. It's been something
that I developed over time and experienced, because I realized that even though it was
easier to calculate with a little bit larger volume, patients walked away with some swelling.
So, what we do is we actually concentrate, as much as it is practical, the units per
volume, so that I can place the material into the muscle and leave as little fluid around
as possible.
So my impression is that this was basically a certain volume of fluid that went into the
muscle, but there is a certain volume of fluid just kind of became elevated out and created
this type of appearance. Now the ongoing effect of the Botox may be partially responsible
for this odd shape.
I noticed in the photo that there is dimpling in the chin and I suspect that was the point
of doing the Botox. What is done is the injection is placed in a muscle called the mentalis
muscle to address chin dimpling. Now I would not in any way contradict your doctor's opinion,
but I think that it is reasonable also to consider just waiting and allowing this fluid
to get absorbed. A lot of times a little bit of massage can go a long way and allowing
this fluid to get absorbed will likely result in resolution.
Now if for some reason this fluid doesn't absorb, then needle aspiration or something
has to be done to get rid of it. But I think that given that it's only been about three
days, it is probably best to maintain the communication with your doctor as far as ongoing
guidance. This might've also been, when the injection was placed, it might've been placed
in a space where the skin may have been a little bit loose and it creates what we call
as a bleb which is at a more superficial layer of the skin, as opposed to the deeper layers
of skin where the fluid tends to just flow out. Sometimes that can potentially happen
and so that may also be the situation here. Your doctor may have wanted to be a little
bit more superficial and may have ended up injecting the fluid at a more superficial
level of the skin and that created this kind of balloon appearance that's more superficial.
Again I think it's something that your doctor and you should probably be able to resolve
without too much aggressive intervention and hopefully what I've said to you is helpful,
so once again I hope that was helpful and wish you the best of luck. Thank you for your
question.