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We all know what "bad" Botox looks like—the scary stuff associated with Beverly Hills housewives and Hollywood stars who have gone too far and can no longer move their facial muscles; or, worse yet, have what appears to be drooping eyes or brows.
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. We spoke to dermatologic surgeon Dendy Engelman, M.D., of Medical Dermatology and Cosmetic Surgery, to understand what happens when a Botox job goes wrong, and whether or not the damage can be undone.
So what exactly constitutes "bad Botox," and what happens when Botox ends up looking scary, instead of making someone look like a better, younger version of themselves? Engelman categorizes bad Botox as falling into two camps: "The first is when it is very obvious that the patient has had Botox performed. This can manifest in brow asymmetry, lid ptosis (drooping eyelid), and inability to move the forehead at all," she explains. "The second would be when the patient is unhappy with the results."
Risks of Getting Botox
"Most commonly, bad Botox results because the rules of injection of neurotoxin and strict adherence to the knowledge of facial anatomy have not been followed," says Engelman. Translation: Someone injected where they shouldn't have, and it looks bad.
"When neurotoxins are placed improperly, this can result in facial asymmetry (one side not matching the other), drooping of the eyelids or eyebrow, and double vision. A bad habit of old was to inject entirely too much product into the face, and this resulted in an expressionless face (because the patient was unable to make any movements to express emotions)," she explains. "Thankfully, the injecting trends have steered away from that aesthetic (in most markets), and I feel that change is for the better. The goal in neurotoxin administration is to give a more relaxed and youthful appearance, without appearing as though one has done anything."
How to Ensure You Get The Best Treatment
We had Engelman break down exactly where a person should not inject Botox, and she explained that, in most cases, Botox is used from the cheekbones and above, so, "for lines between the brow, forehead wrinkles, and wrinkles around the eyes." Botox is the only neurotoxin that is FDA-approved for both the brow and crow's feet region. Engelman gave us this handy rule of thumb to remember when it comes to Botox: "Dermatologists use filler from the cheeks to the chin and Botox from the cheeks to the hairline. So, that said, the ways to tell when Botox has been done incorrectly is if one eyebrow goes up higher than the other when eyebrows are raised, if one eyelid or eyebrow looks lower than the other or appears to be drooping, and if a patient's smile looks asymmetric or unnatural—this can be a result of misplacement of neurotoxin or too much injected into the crow's feet region," she says. While this is a general rule of thumb, keep in mind that Botox can in some cases be used below the cheeks, including treating the masseter for jaw slimming and TMJ, treating chin dimpling, smoothing the upper lip lines, performing a lip flip, or treating the corners of the mouth.
What to Do If You've Gotten Bad Botox
As for the million-dollar question on whether anything can be done to correct bad Botox, Engelman says that it depends. "If too much is used and a person is left expressionless, this cannot be reversed," she says. The good news is that it's not permanent. "The patient just has to wait until the neurotoxin wears off, which is typically between ten to 12 weeks," says Engelman. (For the record, Engelman noted that some people love the "frozen" look and request it).
However, if the results are not quite even, there is something that can be done beyond waiting for the Botox to wear off. "If a patient experiences brow asymmetry (where one brow goes up higher than the other when eyebrows are raised), this is easily fixed by injecting a little more product into the stronger side. This is a common occurrence and is easily corrected," she says.
We were initially confused by this answer—add more Botox to fix a brow higher than its partner? But Engelman explained: "This is a tough concept and a common misconception. Contrary to popular belief, botulinum toxin (Botox) actually stops or limits muscle contraction, so it actually doesn't tighten muscles—it, in fact, does the exact opposite. So, if a muscle is still contracting after injection (leading to a higher elevation of the brow on the stronger side), adding more into it will stop it from being so 'strong' and will allow for the brow to lower, leading to better symmetry."
Know Your Pro
So remember that you won't be frozen forever, and always do what you can to prevent bad Botox from ever happening in the first place. Says Engelman, "Although it looks fairly straightforward, there is an extreme amount of knowledge that goes into meticulous injection technique and solid knowledge of the underlying facial anatomy. Don't bargain shop for your face. Make sure you research who you are soliciting to inject toxins into your face. Make sure you always seek a licensed, trained, board-certified professional. I promise that no amount of money saved is worth the potential for a bad outcome. Your face is worth the investment!"
We also suggest going in for a consultation before you get the actual injections. What you have in mind as a correct injection placement could be different from what the doctor knows is the best option for the results you want.
Food and Drug Administration. BOTOX® Cosmetic (Boe-tox) (onabotulinumtoxinA) for Injection. Updated January, 2016.
Trévidic P, Sykes J, Criollo-Lamilla G. Anatomy of the lower face and botulinum toxin injections. Plast Reconstr Surg. 2015;136(5 Suppl):84S-91S. doi:10.1097/PRS.0000000000001787