Ask Charlotte: What's The Botox Shelf?

Whether it's the Spock brow, puffy cheeks, or over-injected lips, it's easy to tell when Botox is overdone or done wrong. But have you heard of the "Botox shelf"? It's yet another sign of too much (or poorly administered) Botox, and a reader wanted to know more about the occurrence.

Q—READER:

What is the "Botox shelf" and how do you avoid it?

A—SHEREENE IDRISS, DERMATOLOGIST

According to Dr. Shereene Idriss of the prestigious Union Square Laser Dermatology, the “Botox shelf” is the result of too much Botox being placed around the eye muscles, and is sometimes seen in conjunction with a bulging upper cheek.

The Anatomy

"In order to understand the Botox shelf, it's important to understand the basics of facial anatomy," Dr. Idriss tells us. "The orbicularis oculi is the circular muscle around the eye, and below it is the cheek muscle," she continues. "These are the two muscle groups that are affected by the Botox shelf."

The Cause

Dr. Idriss explains that when Botox is injected in the outer eye area to minimize crow's feet, the upper cheek muscles can indirectly be affected. "This depends on the depth and concentration of the Botox that's used," she says. "If this happens, the upper part of the cheek appears flattened (and paralyzed), essentially creating a Botox shelf that presses down on the cheek. The result is a protruding lower cheek." "When you inject Botox into the muscles around the eyes, obviously the muscles will relax," Dr, Idriss tells us. "But the muscles that lift your cheeks do not relax. A Botox shelf can form at the upper outer cheeks, pushing back onto the rest of your cheeks and giving them an apple-like shape." Oftentimes this might even be mistaken for "bad filler," according to Dr. Idriss.

How can you avoid the Botox shelf?

Dr. Idriss warns that sometimes doctors address crow's feet with Botox when filler might be a better solution. “These two areas of the face are very related," she says. "That's why sometimes when women come in saying they hate their crow's feet, Botox is not the answer. More often than not, crow's feet are due to a loss of underpadding and volume in the temples, and therefore can easily be addressed with hyaluronic acid fillers.  

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