Hi Dr Lam. I have had this procedure twice with 2 separate surgeons (both well qualified and used to the procedure), but both times (the second much worse, the first was mild) I had some kind of diffusion issue and ended up not being able to smile properly. My cheeks wouldn't pull up properly and mouth corners not curl upwards they sort of stayed horizontal no matter how much I tried to smile fully. So my attempt at smiling looked more like a sneer. And this lasted the entire time the botox did, it wasn't temporary. Why did this happen both times? I didn't lie down afterwards or anything like that and they knew to inject deeply so am I just somone who can't have this procedure without the complication?? Are there types of botox or concentrations that are more likely to cause diffusion? Would not smiling at all for a specified time post injection help stop it from travelling into the 'smile' muscles?
this is a technical error. that is all. i had this a couple of times 7 or 8 years ago when i started but have not seen this since that time due to a very precise injection technique. this is why i have about half of my botox jaw reduction patients fly in for my work. at high doses you must be highly precise. best, sml
Samuel M. Lam, M.D., F.A.C.S.
Diplomate, American Board of Facial Plastic & Reconstructive Surgery
Diplomate, American Board of Otolaryngology Head & Neck Surgery
Diplomate, American Board of Hair Restoration Surgery