Botox Mishaps

By Jerome Edelstein, MD

Botox is a well-known treatment to smooth facial lines and wrinkles, refresh a tired look and turn back the clock. Every medication carries risks, however, and although Botox has a very good, long term safety record, there are side effects to be aware of when planning your treatment. A quick search on the internet will turn up plenty of disturbing, anecdotal tales of Botox mishaps and unexpected results. Unfortunately, with the variety or practitioners available for treatment, the buyer must beware of the specific training and experience their injector has to ensure qualified care and avoid common pitfalls.

Most potential Botox patients can readily picture the “frozen face” look that they do not want. Occasionally a well-known celebrity appears to have smoothed their forehead and eye area to the point that they look like they are wearing a motionless mask and they can no longer raise eyebrows or emote normally.

Living life in the limelight means that these temporarily overdone results are kept for posterity in public pictures. Though a few people may request that look, many more will specifically request to avoid it and fear of looking frozen or fake may keep them apprehensive about Botox treatment. Most experienced injectors will agree that eliminating wrinkles is the goal, not eliminating all facial movement.

Be sure to discuss your goals with your injector beforehand and aim to underdo the application of Botox if it is your first time, not overdo. You can carefully adjust your treatments over time as you learn what works for you. Unfortunately the antidote to a Botox mishap is time- you must wait for at least 4 months for it to wear off.

Another commonly reported issue is “Spock” brow. When one or both eye brows lift up at the middle or ends, creating a quirky, surprised look, this can be referred to as Spocking. An experienced injector will typically be able to prevent this with a careful balance of Botox between the various brow muscles. A tiny dose of Botox, applied to the muscle which is pulling too high can be administered at a follow up appointment quickly and easily.

BOTOX TREATMENT

The feeling of a heavy, dropped forehead can also occur with too much Botox applied to the frontalis muscle over the forehead. This issue really requires a skilled, individual assessment before application because we all use our various muscles to different degrees, and existing anatomy such as hooded eyes or a large forehead would mean taking extra precaution in this area to prevent lowering the brow further. If the forehead is too relaxed and appears lowered, the patient must wait for the Botox to wear off over 3-4 months, then remember to let future injectors know about what didn’t work well for them previously.

Extra care and precision injection must be used when injecting around the mouth and facial muscles which assist with smiling or frowning. Common problems associated with treatment in this area can include an asymmetric smile or visible lop-sided differences when using facial muscles, talking or chewing.

One-sided facial droop can occur when injection to the crow’s feet are administered too deeply or the product migrates from the area to affect muscles which pull up on the corners of the mouth. Only an experienced injector should use additional Botox to even out lop-sided results.

In most cases, less is more and waiting for the product to wear off if the least problematic route to take. Botox treatment around the eyes targeting crow’s feet has also been known to make lower eyelid puffiness and baggy appearance worse as the product spreads to supportive tissue structures around the eyes.

Eyelid ptosis or eyelid droop is less common than overall brow lowering. Brow Botox injection which affects one eye to the point that the upper eyelid sags noticeably and into the line of vision should be reported and treated by your doctor. There are special eye drops which can be used in these cases to improve vision and temporarily assist with lifting the lid until Botox wears off.

In most cases, Botox which was injected in excess or incorrectly will require plenty of patience as you allow it to wear off. Be sure to seek very experienced injectors and not to make your treatment decisions based on cost alone. It is also imperative that you follow your injector’s instructions for care after treatment, such as avoiding pressure application to the treatment area, heat, sweating and working out directly after treatment. Report any concerns or issues that you have right away so that your doctor will be aware of problems and can touch up and adjust results to make minor corrections.