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Where Not to Inject Botox® — Tales of Botox Fails

Botox® treatment is an incredibly common cosmetic procedure. It’s so common and seemingly so routine that many patients and would-be providers assume anyone can do it.

That’s not the case. Improper Botox administration increases the chances of side effects and complications ranging from mild and temporary:

  • Redness, swelling, or bruising at the injection site
  • Dry or excessively watery eyes
  • Headache and chills
  • Droopy or lopsided eyebrows and eyelids (ptosis)

To severe or even life-threatening:  

  • Persistent muscle pain or weakness
  • Loss of bladder control
  • Difficulty speaking or swallowing

Botox Fails Can Happen

The vast majority of Botox patients experience few if any side effects. But some work with poorly trained providers and get more than they bargained for. Like these real-world Botox fails:

Ptosis Peril

Chicago-based lifestyle influencer Whitney Buha received Botox treatments for years with no complications. 

That changed in early 2020, when a routine injection to smooth fine lines around her eyes left her eyebrows uneven. So Buha returned to the spa for a second procedure to “smooth things out.” 

And that’s when the real trouble started. Within days, Buha’s right eyelid was drooping noticeably — a condition known as ptosis. Her left eye widened to compensate, giving her a wild facial expression. 

Fortunately, Buha’s ptosis proved temporary and didn’t sour her on Botox treatments. But it’s a reminder of the importance of working with trained injectors.

Permanent Puffing?

Kathy Leeman, another longtime Botox user, attributed sudden, unusual puffiness under her eyes to repeated injections. She tried several topical fixes, like creams and rollers, without much success. Finally, she found a corrective that worked: acupuncture. 

Crooked Chin

Nikita Kimberly’s story is a reminder of the risk of off-label Botox injection at the hands of poorly trained providers. 

 

Kimberly, a TikTok influencer, sought out Botox treatment for chin dimpling, a less common indication that’s best left to trained professionals. The injection left her with a crooked smile, a swollen left chin, and an aversion to further treatment — though her facial symmetry should return in a few months, after the medication dissipates.

Botox Injection Mistakes: Where Not to Inject Botox

To reduce the risk of both minor side effects and potentially serious complications, injection of botulinum toxin is best left to properly trained medical professionals. Capable injectors know precisely where to inject Botox — and, more importantly, where not to inject Botox:

  • Injecting the frontalis muscles (the two main forehead muscles above the eyebrows) instead of the corrugator supercilii muscle (smaller muscles around the eyebrows) can cause a “Mephisto Effect” or “Spock brows” — comically arched eyebrows.
  • Injecting the wrong area of the orbicularis oculi muscle, a key upper eyelid muscle targeted in the treatment of crow’s feet.
  • Over-diluting Botox injections of the lower facial muscles, which can result in downturned corners of the mouth and temporary facial asymmetries like Kimberly’s.
  • Injecting the muscles of the chin instead of the nearby masseter muscle, which responds well to Botox treatment in patients with bruxism and mandibular hypertrophy.

This Botox face chart has more “do’s” and “don’ts” for Botox injectors — and patients who want to keep them honest.

Botox Is Better With a Trained Provider

Botox is always better with a trained provider, whether they’re a licensed nurse or a board-certified dermatologist. 

Before agreeing to a course of treatment, always ask your provider if they’ve completed comprehensive Medical training for botulinum toxin treatment. And if you have other cosmetic needs, know that trained Botox providers are likely to be certified in other popular cosmetic procedures, like dermal fillers and microdermabrasion.