Most people know Botox for its cosmetic effects, like minimizing the appearance of wrinkles, but Botox has been used for years to treat conditions from hyperhydrosis, to migraines, to TMD (or disorders that stem from problems with the jaw joint and surrounding facial muscles). When it’s used on the face, a little dose here and there can halt the signs of aging (should that be something you’re interested in doing), but sometimes too much of a good thing can produce less than stellar results. Especially as graduations and wedding season approach, consumers want to beware of the pitfalls and potential side effects of Botox procedures and make sure they go to a reputable and reliable practitioner. Keep in mind that with an experienced and talented doctor, PA-C, or nurse, these problems are very rare.  On the other hand, places that discount prices are often cheap for a reason. Whether you’ve experienced bad Botox yourself and are seeking answers, or have been too afraid to try it for fear of the worst-case scenario, you’ll want to keep reading.

The Frozen Face

  Usually it’s the forehead, but I’ve seen people who look like the only moving part is their mouth. Hollywood, are you listening??? I call it the Oscar Night Freeze. We’ve all seen this: the expressionless face. The result looks slightly robotic and not natural in the least. The frozen face may not be a mistake in that some injectors are going for that look.  And oddly enough a few people want it. But I think most would prefer to look more natural.  I believe the goal should be no wrinkles, not no movement. If too much Botox was injected and your face doesn’t move, you’ll just have to wait for it to wear off.  Unfortunately, there’s no quick fix for this.  When you dip your toes back in the Botox waters, take the time to find a good injector that understands your goals.

A Mr. Spock Eyebrow

  Think Star Trek.  Remember the one quizzical eyebrow – or was it both??? At any rate, another Botox error is when the treatment results in one or both eyebrows elevating so much that the patient has a chronically surprised look. In addition, odd wrinkles can occur over the lateral brow. A good injector can usually prevent this. This can also be fixed rather easily and quickly (usually at no charge) with a few strategically placed drops of Botox to relax the muscle that’s pulling the eyebrow up too high.  Don’t suffer in silence, go to your doctor and ask him or her to fix it for you.

Your Forehead Feels Heavy and Your Eyelid Looks Droopy

  This is a fairly common error and results from over-Botoxing the forehead, specifically the frontalis muscle, which goes all the way across the forehead and is used to raise the eyebrows. Too much Botox can relax the forehead too much, which results in that heavy feeling.  One person I know described it as feeling like an elephant was sitting on her forehead. And when the forehead comes down, so do the eyebrows. Since those of us who have some excess eyelid skin (called hooding) raise our eyebrows a lot to make the eyes feel more open, then dropping the eyebrows makes the eyelids look worse, or more hooded. The feeling is like you can’t fully open your eyes.  If the doctor doesn’t correctly perceive how much the patient uses this muscle, then too much Botox will cause the upper eyelid skin to look more hooded. Fixing this one is just tincture of time.  You just have to let it wear off.

Other Botox Mistakes:

True Eyelid Droop

  This is the complication you read about most often, though it’s actually one of the rarest. Most of the time, it’s the forehead and eyebrows that have dropped, which is described above, and it makes the eyelid feel heavy. If you truly are having trouble opening one of your eyes, call your doctor. There are prescription eye drops that will temporarily help elevate the eyelid, making this problem bearable until the effects of the Botox have worn off.

Lop-Sided Facial Features

  Now that Botox is being used by more injectors in the lower face, it’s sometimes not done well.  Since people often come to my clinic to fix Botox mistakes, here are some of the things I’ve seen.

Lop-Sided Smile

  When the muscles that control the shape of the mouth are injected incorrectly, it results in one side of the smile pulling up or down.  Usually this is more noticeable when the face is in motion, but not always. There are a number of ways to make this look better until the Botox wears off, so see a Botox expert in your community.

A Facial Droop on One Side

  Fortunately, this is rare.  It usually occurs when the Botox injected around the lower crow’s feet or eyelid migrates to a muscle that elevates the corner of the lip and parts of the cheek. On this one, you just have to let it wear off.

The Lower Eyelid Area Looking Worse After Botox

  This is usually caused by too much relaxation of the muscle around the eye called the orbicularis oculi.  In some people who already have a tendency for that muscle to loosen over time, Botox in the crow’s foot area will make the puffiness and crepiness on the lower eyelid worse. Talk to your doctor about solutions.  Sometimes an eyelid Fraxel treatment or an eyelid Thermage treatment to tighten or smooth the eyelid skin will help.  Sometimes the only solution is to not use Botox in certain sections of that muscle.

Finding a Great Doctor/Nurse to Do your Botox

  One, look at your friends and ask them. Not everyone will be honest of course. But many will. If you like the way your friend looks, chances are you’ll like their doctor.  Two, schedule a consult if you can and find out how many years the doctor/nurse has been injecting Botox (at least 5 years is good). Again, not everyone will be completely up front about this. You can also try calling the front desk staff of an office and asking them.

Resources: SkinTour, Byrdie

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