Question :

Dear Cosmetic Courses,

I attended your basic and advanced courses in 2005.

I recently treated a 37 year old lady using Azzalure 3 x 0.1ml (15iu in 0.1ml) bilaterally to her orbicularis occuli. I performed my usual technique, injecting into the sites I usually inject into, and making sure I did not inject too low down on orbicularis occuli.

She came for review 2 weeks later, complaining of a heaviness over her cheeks making smiling difficult, more so on the right side.

Could you advise on any intervention that may alleviate this?

I have heard of practitioners advising stimulating the muscle using an electric tooth brush?

Answer :

It does sound like some of the Azzalure may be affecting your patient’s Zygomaticus Major or Minor.

This would cause the symptoms which you describe and is usually caused by the lowest of your crows feet injections.

We have seen this once before and it was caused by Dysport- there is some evidence that Dysport and Azzalure may disperse more than Botox making side effects like these more likely.

Unfortunately, there may not be much you can now do to alleviate it other than being supportive.

The electrical toothbrush trick may work and is certainly worthwhile trying, to both muscles 3 times a day for 5 minutes.

Good luck with this case and let us know how it goes.

The Cosmetic Courses Team