Botox Gone Wrong – Why Does Bad Botox Happen?

When I see new patients who want Botox for the first time, they often bring up examples of Botox gone wrong. So what exactly is Botox gone wrong? And why does bad Botox happen? FYI, I use two types of neurotoxin in my practice – Botox and Xeomin. But for the sake of simplicity I will refer to all neurotoxins as Botox.

How does Botox work?

Botox is a neurotoxin produced by the Clostridium botulinum bacteria. The toxin acts at the junction between nerves and muscles, and blocks the nerve from transmitting signals to the muscle.  So injecting small amounts directly into a muscle results in paralysis of that muscle.

Botox only works on dynamic rhytids, meaning those that appear with facial expression. If you have visible wrinkles when you aren’t frowning or raising your eyebrows, you may need fillers or laser resurfacing to get an optimal result.

Botox is most useful on the upper third of the face. I use it over the forehead, on the frown lines between the eyebrows (affectionately called the “elevens” by Allergen, the company that manufactures Botox), and on the crow’s feet around the eyes. I will occasionally, and cautiously, inject Botox around the mouth. But because it paralyzes muscles, using too much Botox or putting it in the wrong place can cause difficulty speaking and eating. If you’ve ever seen Christmas with the Kranks, the scene where Tim Allen is drooling after getting botox is a great, although exaggerated, example of what could happen if you were to get Botox injected around the mouth. Granted, it would actually take 5-7 days for the Botox to kick in, but then the movie wouldn’t be as funny.

So why does Botox make people look fake?

There are three common examples I see of Botox gone wrong:

• If your face is totally frozen. I think we’ve all seen that expressionless person who wouldn’t blink an eye if she had a gun pointed at her face. You know. Because she can’t. I’m a big proponent of a natural result, and I think your face should move at least a little bit after Botox injections. Granted, I have patients who like a more dramatic result. And I’m happy to tailor my treatment to their preferences. But my go-to treatment result is very natural.
• The Spock eyebrow. When botox is injected only over the central forehead, the lateral brow can arch too much and make you bear an unfortunately resemblance to everyone’s favorite Vulcan. Fortunately this is totally correctable; injecting a little Botox over the lateral forehead will take care of the problem.
• The eyelid droop. Drooping of the upper eyelid can happen when Botox diffuses into the muscles that raise the upper eyelid. This is thankfully very rare; I’ve actually never seen it happen.  The eyelid droop does go away in a couple of months when the Botox wears off, and eyedrops can improve it in the meantime.

Now that you know what causes Botox gone wrong, how do you avoid it? If you want a good result, go to a good doctor. Plastic Surgeons and Dermatologists have special training in cosmetics and facial anatomy that make them the experts at injecting Botox and facial fillers.