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Is Botox most effective when injected directly INTO the muscle?

Dr. Dean Kane Q & A.shutterstock_59306794 Q. I recently got Botox to treat my 11’s. One side took, and I clearly noticed the “crunch” of the needle into the muscle. The side that did not “crunch,” barely took and had to be redone a few weeks later. I was told it was because one side was “stronger.” What gives? A. Botox is an injectible muscle relaxer with a science and an art. Those injectors who understand anatomy and muscle function / expression are best suited to achieve the results you desire. ​ ​Yes, the best results for Botox placement are in the muscle desired to relax as the nerve/muscle connection where Botox works occurs within muscle fibers and not outside the muscle bundle. There are many factors in the art of injection. These include:
  1. ​Understanding which muscle(s) to inject to achieve the balance or dynamic tone of expression
  2. ​ At what level to inject to achieve the best accuracy and limit diffusion of the liquid outside of the muscle fibers themselves
  3. The amount (number of units and amount of fluid) to inject at each site
  4. The angle of the needle and the orientation of the needle bevel
Anatomically, the “crunch” you heard maybe the needle passing through the skin, fascia, muscle covering or bone covering. These are tougher tissues which create a  “crackle” or “crunch” as the needle pops through. It is possible that the fluid delivery was not directly into the muscle and held in place by the muscle covering but may have partially flowed outside the muscle delivering less units of Botox. ​ ​Functionally, patients do show asymmetric variations in facial expression. This may be due to individual personality or variations in muscle size, attachments and bone position. ​ ​As you see, there are many factors in the “not so simple” technique of injecting Botox and the resultant effects. It is best to be treated by a well experienced Board Certified “core” physician trained to inject this drug. These include: Plastic Surgeons, ENT Facial Surgeons, Occuloplastic Ophthalmologists and Dermatologists. ​ ​I hope this was helpful. All the best!
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