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Botox disasters

Updated: Aug 2, 2023

Many people are curious about having a Botox treatment but don't really understand what it is, or what it does. Many people are concerned that they will end up with some irreversible result that looks awful and be scarred for life. These fears are understandable, probably due to social media and celebrity treatments that have gone wrong, however Botox treatments are generally quite safe. As long as you are not allergic to the products, which will have been established in your pre-treatment consultation prior to your prescription, the things that can go wrong will resolve with some additional treatment or time.


The effects of Botox wear off after 3 months or so. This is bad news if you were happy with your results as you will need further treatment, however it’s great news if you have had a bad result or heavy treatment. It’s important to understand that each treatment is not the same. Everyone has different facial shapes and muscle size and strength. A treatment does not mean you will end up looking frozen and have no facial expression. This is the result of too many injections and / or too many units at each injection site. A well thought out treatment should be subtle and will still allow a little movement so (unless you know what you are looking for) others will not really notice you’ve had a treatment.


There are some things that can go wrong but there are things we do to mitigate risk and prevent adverse reactions. Unfortunately, the injections can be a little uncomfortable (no worse than having acupuncture) and there is some redness and bumpiness that passes after 15-30 minutes. There is sometimes a little bleeding, and although we try to avoid this, there can be some small bruises. If bruising happens you simply need to use ice and some foundation the following day to cover it up.


Botulinum toxin (which includes the brand Botox) is a prescription only medication that needs to be prescribed to you by a healthcare professional and they will have screened you for allergy. This is a very small risk. There is also a possible risk of overdose (as with any medication), however the amounts used for an aesthetics treatment are way below this dose, so it is perfectly safe.


There are three main adverse reaction, or undesirable results that can occur. They all mainly occur through faulty injection techniques and poor placement of the product. That said, even when we treat carefully, we can significantly reduce these risks but can’t completely eliminate them. Even if they occur, they can be treated for improvement, and they will resolve as the Botox wears off.


Brow ptosis


A brow ptosis occurs when the frontalis muscle is relaxed from treatment and causes the brow to descend and create a heaviness over the brow. This happens if the frontalis is treated too heavily, too low or too laterally over the outer edge of the brow. Simply treating higher up on the forehead, using less units in smaller, weaker muscles and avoiding treating over the lateral brow will help to avoid this result.


Lid ptosis


This happens when the levator palpabrea muscle is exposed to Botox. This muscle sits deep, inside the orbital rim and is not normally reachable. However, there is a small foramen (hole) where nerves and blood vessels exit the skull. Having Botox treatment that is injected too deep, just above the brow in the mid pupil line can increase the risk of the product passing down to this muscle. We avoid this by lifting the muscle as we inject and not injecting too deeply.


Spock brow


A Spock brow occurs when the medial brow area is over treated, whilst the lateral brow is left untreated, remains active and lifts the corner of the brow up. This can be avoided by not over treating the medial brow. If it does happen, we simply deactivate the lateral brow with a little product to reduce the overactivity and allow the brow to drop back down a little. Remember though that this will resolve in time, usually starting to change after 6 or 8 weeks.


We can avoid these undesirable results by marking up prior to treatment and sticking to the licensed dose or less…




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