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.
We spoke with Joshua Zeichner, MD, director of cosmetic and clinical research in Dermatology at Mount Sinai Hospital in New York City, to find out exactly what Botox is, why some people may be unsatisfied with the results, and how to correct a “bad” Botox session.
Meet the Expert
Dr. Joshua Zeichner, M.D. is a dermatologist, as well as the Director of Cosmetic and Clinical Research in Dermatology at the Mount Sinai Hospital in New York City.
Avoid Future Mistakes by Understanding How Botox Works
Aside from conducting the necessary research before you proceed with Botox, the best way to get the results you want is to understand what Botox is, why it works, and how it’s used.
“Botulinum toxin works by blocking the signal released by your nerves which stimulates your muscles to constrict,” Zeichner says. “By relaxing specific muscles of facial expression, you can temporarily prevent the overlying skin from folding, which allows the skin to fill in wrinkles that have already developed. Continuous use can also prevent lines from becoming etched into the skin to begin with. These toxins are commonly used to treat the '11' wrinkles between the eyebrows, horizontal lines on the forehead, and crows feet wrinkles around the eyes.”
So, how can a Botox treatment turn bad? That all depends on how the toxin was administered. “Your outcome depends on the pattern of injection in the face,” Dr. Zeichner adds. If too much is administered (or administered in the wrong areas), drooping or overly-frozen expressions can occur.
When it comes to Botox, there’s good news and bad news. The good news is that Botox is a procedure that produces temporary results, meaning even a “bad” case of Botox will eventually disappear over time. The bad news is that not much can be done to reverse the effects. This is of course not a settling thing to read, but when it comes to a bad Botox experience, being patient and allowing time to pass will pretty much be your only sure bet at correcting the procedure.
"Botox is a non-invasive way to give significant and long-lasting cosmetic improvements to the face," says Zeichner. "The procedure is quick and relatively pain-free. The effects of Botox are long-lasting, so once you get the treatment, there is not much to do but wait for it to wear off, and results usually last between three and five months." For example, if the eyebrows are flat and drooped because of over-treatment, then Zeichner says that all you can do is wait for the effect to wear off. That said, there are a few tips and tricks that may help minimize or hide unwanted effects until the procedure has had time to wear off (which you'll find below).
Add More Botox if the Conditions Call for It
“If you have an issue that can be corrected by adding more Botox, then 'bad' Botox can be improved,” Dr. Zeichner says. This tactic won’t work for someone who has simply received too much Botox, which often results in a “frozen” look, but it can help if the injections are asymmetrical, in which case, a bit more can be added to the other side of the face to even things out. For example: Because Botox temporarily weakens or paralyzes the muscle, if one side of the face is still able to move causing a "stronger" and more elevated look, then adding more Botox in that area will help to relax the muscle and even the plane.
Know When Enough is Enough
Sometimes, the best way to fix a problem is to take a hands-on approach, but this is definitely not always the case when it comes to cosmetic procedures, so always be sure to talk to your doctor before you automatically look to another session as the answer.
“More Botox is not necessarily better," warns Zeichner. "The goal of treatment is not to freeze the face completely, but rather to provide a natural appearance where the face can still move. Over-treating the forehead can result in the eyebrows becoming dropped or flat. Injecting only the middle of the forehead can cause a 'joker eyebrow,' where it looks over-arched. Over-treating the crows feet can actually interfere with your smile. Rarely treating the 11 lines can cause a droopy eyelid.”
Whatever you opt to do with your Botox treatment, it’s best to start slow and work your way up, and always take the time to research the person administering the treatment for the best results. “It is important to be treated by an experienced injector to minimize this risk," Zeichner says. "Getting bad Botox does not mean that Botox is bad. Your outcome depends on the skill and aesthetic of your injector. Just as you may not like a haircut at one salon, it doesn’t mean that you won’t be happy if you go to another one."
Look to Treatments Containing Copper
Because Botox paralyzes facial muscles by blocking the nerves, there isn’t much to be done to reverse the effect, although, according to a 2017 study, copper may inhibit the effects of the toxin.
“Copper has been shown to help reverse the effects of Botox injections," offers Zeichner. "It is unclear, however, whether copper supplements or copper containing topicals may be effective in reversing the effects of Botox. Copper peptides, an increasingly popular skincare ingredient, is known for offering some of the desired side effects of Botox when applied to the skin, and is found in a number of serums, like the Korres Golden Krocus Ageless Saffron Elixir Serum.
Stay Away from Zinc
While there is no magic ingredient that will immediately correct the effects of an undesired Botox job, some minerals may improve the effects of Botox.
“Zinc may enhance the effect," says Zeichner. "Many doctors recommend their patients take zinc supplements when they get their treatment for a better outcome. Zinc is known for being effective in treating acne for its antioxidant properties, so be sure to check the ingredient labels for zinc on your skincare products."
In terms of diet, zinc-rich foods include meat, eggs, whole grains, and legumes, but always make your overall health a priority before making changes.
Fool the Eye With Makeup
While you can’t technically reverse the effects of a cosmetic procedure, you can look to makeup tricks to disguise unwanted effects (or enhance others).
“You may be able to apply your makeup in a different way to compensate for the changes associated with bad Botox,” Dr. Zeichner states. Drooping eyes can be made to appear lifted by focusing on the lashes, or adding concealer, highlighter, or winged eyeliner, in some cases. Brows can be evened out with brow pencil, powder, or gel, and styling your hair to complement your facial structure can be a quick, temporary fix while you wait for the effects of Botox to wear off.
Familiarize Yourself With Botulinum Toxin Brands
The term “Botox” has become synonymous with botulinum toxin, but there are actually several brands of the ingredients available, some of which may yield different results depending on the person.
“Botox is one brand of botulinum toxin used cosmetically to improve the appearance of wrinkles caused by facial expressions," explains Zeichner. "Other brands of botulinum currently available include Dysport, Xeomin, and Jeuveau." Along with these, Zeichner says there are two toxins being developed that should come to the market. "The first is called Bonti from Allergan, The makers of Botox," he says. "This toxin has a quick onset of action, and its effects are short-lived. It will be a good option for first-timers or for people who need to get a last-minute treatment. Daxi is a longer lasting toxin from Revance Therapeutics [and] should give improvement for at least six months.”
Bremer PT, Pellett S, Carolan JP, et al. Metal ions effectively ablate the action of botulinum neurotoxin A. J Am Chem Soc. 2017;139(21):7264-7272. doi:10.1021/jacs.7b01084