• By Julia Gibson January 29, 2020

As an intermediate Botox-er (I’ve had it done only a small handful of times), I went into my last appointment without hesitation. I’ve done it before, what would I have to be afraid of? A few days after the treatment, I had a creeping feeling that I didn’t quite look like myself anymore. Not in the my-lines-are-gone-and-my-forehead-is-poreless type of way; my brow felt heavy and I could tell that my eyes didn’t look as open as they usually do.

Then it hit me: I had become a casualty of Botox gone awry. The results have now worn off, but ever since, I’ve been curious about what went wrong. I decided to chat with FACILE dermatology + boutique Co-Founder Nancy Samolitis, MD, FAAD, all about what a bad botox treatment looks like, why it happens, and what you can do to help if you, like me, find yourself unhappy with results. And now I’m pretty sure that I napped a little too soon after treatment…learn from my mistakes!

JG

What does a bad Botox treatment look like?

NS

When Botox “goes bad”, that usually means that the active molecule diffused into a muscle that was not intended to be treated. For example, when the injections are done for the frown line between the brows, the eyelid muscle can be affected causing a heavy eyelid or when the chin is treated, the lower lip smile muscles can be affected causing an unnatural or asymmetric smile. In many cases, the forehead can be the least forgiving area with incorrect injection points leading to flattening of the brow or excessive peaking of the brow [sometimes known as “spocking”]. This may happen on both sides or one side and is easily recognized as “Botox gone wrong,” Luckily, all of these problems can be corrected by an injector who understands why the problem occurred and what to do to change the muscle activity.

JG

What can go wrong during a Botox treatment?

NS

The wrong muscle can be treated by an injector who does not understand anatomy including the variations that occur in different people. A well-educated injector rarely makes these “mistakes”, but everyone’s anatomy does not always follow textbook rules, so occasionally, imperfect results can occur in any case. A good, reputable injector should recommend a follow up in 1-2 weeks when the treatment is fully kicked in so they may determine your response and correct any asymmetry or undesirable outcome. An inexperienced or uneducated injector can potentially cause many complications including changing your natural smile, causing areas to look frozen, or even more serious complications like difficulty swallowing.

JG

So I got a bad treatment and I’m unhappy with the result. What can I do to correct it?

NS

If you are unhappy with your result, ALWAYS go back to your injector to express your concerns. If your injector is experienced and ethical, they will most likely correct you at no charge. We strive to produce an ideal result in everyone, but it sometimes takes a few treatments to get to know how your body responds. If your injector is unwilling to help you, get a second opinion.

JG

What should patients do for treatment prep and aftercare?

NS

The only pre-treatment measures that one needs to take would be to help avoid bruising. This is a rare, but possible, side effect of any injections and are more likely to occur if you have ingested any blood thinners in the past 2 weeks. The most common culprits are aspirin, ibuprofen, vitamin E, fish oil, and alcohol, but there are likely other supplements that can contribute to bruising as well. Bruising is usually mild and temporary, but it is always ideal to walk out bruise-free. For aftercare, we have several recommendations: 1. Do not participate in strenuous exercise for the next 24 hours. 2. Do not have a facial, massage, or lay face down for an extended period of time. 3. “Exercise” or move the injected areas for about 30 minutes after injections. A recent study showed that this activity improved results.

JG

How can I ensure I’m getting the best treatment possible?

NS

Research your injector! Don’t be afraid to ask questions like “how long have you been injecting?”, “how many patients have you treated?”, “what can go wrong?” (if the answer is “nothing!” then be worried!), “what are your credentials and/or how were you trained?”

JG

How do I choose a good provider?

NS

The best providers are board-certified dermatologists, plastic surgeons, and other providers (NPs and PAs) who were trained by those physicians and have access to them on-site to assist in case of complications. Dermatologists and plastic surgeons were the first to use these techniques and have been the pioneers in studying the safety and efficacy of these drugs for FDA approval. Unfortunately, many medspas and offices hire uneducated injectors without proper supervision, so you can expect, if you are searching for the best deal on Groupon, you may end up with this type of provider.

“If you are unhappy with your result, ALWAYS go back to your injector to express your concerns.”

JG

What are the biggest health risks associated with Botox treatments?

NS

Thankfully, there are no significant health risks associated with Botox treatments in healthy people. There are certain rare neurological diseases that are a contraindication. Botulinum toxin has been used in humans for various types of treatments for over 50 years, so we do know that the risk of serious side effects is negligible.