Botox Injections: Problems and How to Avoid Them

Botox® is a very safe treatment that can alleviate or repair medical and cosmetic conditions for many patients. While Botox® was first used for medical purposes as described in my previous blog post, the unanticipated side effect of smoothing facial wrinkles for those initial medical patients led to its unprecedented use for cosmetic purposes.

Over the years, Botox® treatments have become more widespread, and today many medical professionals have jumped on the Botox® bandwagon, offering treatments to their patients. With this increase in the number of practitioners using Botox® and the variable skill levels of those practitioners, I have been seeing more and more cosmetic issues, and, in some cases, even medical problems resulting from those less-than-expert treatments.

It takes skill and an intimate understanding of facial aesthetics and the underlying anatomy to create natural and beautiful results with Botox®.

Why Using a Qualified Cosmetic Botox® Practitioner Matters

There are very minute muscles in the area of the forehead and brow where Botox® is most commonly used. Each has its own function. Some muscles pull the eyebrow down, making us scowl or look heavy in the eyelid region, and one big muscle pulls the eyebrows up making us appear open, attentive, and attractive.

I have often had patients come to me complaining about horizontal lines in their forehead. The first thought an unsophisticated medical professional might think is to treat the forehead lines directly. This can be a mistake. To understand this more, we have to think about why we have horizontal forehead lines. Is this a sign of something else or an isolated problem in its own?

Usually the reason people have horizontal forehead lines is because their brows are actually in their natural state resting low on the eyelids. You can determine if this is present yourself by closing your eyes, relaxing your forehead, holding your relaxed brows stable with your hand, and then slowly opening your eyes while looking at yourself in a mirror. If you see an image of yourself with heaviness over your eyelids, it’s likely that you have an underlying droopy eyebrow.

Take a look at the following example. In the first photo, her forehead demonstrates nice brow elevation, but this is due to her raising her brows via forehead contraction. This forehead contraction causes those lines in her forehead. When she fully relaxes, her brows come down and rest on her eyelids. She is only holding her relaxed brows here. She is not “pushing” them down. This is the real position of her underlying relaxed brows and forehead and would be the likely result if someone treated her forehead lines exclusively and didn’t think about why they are there.

When the brows are resting in this lower position, the brain then tells the forehead to contract to lift the brows off the lids. This happens unconsciously and then leads to the forehead rising up and the wrinkling of the muscle which causes that forehead and brow to rise-up as well.

If those muscles raising the brow up are fully Botoxed, the forehead muscle will completely relax and the horizontal lines caused by that muscle will smooth out. However, when that muscle relaxes, the effect it caused in raising the natural droopy forehead and eyebrow relaxes as well and the eyebrow falls into the eyelid space.

Inexperienced Botox® Practitioners Cause Big Problems for Patients

It is a fact that the Botox® can drift over the forehead rim into the eyelid and affect the ability of the eyelid muscle to raise the lid. This causes a true eyelid droop, also known as Ptosis. This can be seen in the photo below of a woman with a drooping left upper lid.


Reversing this condition requires 3-4 months for the Botox® to resolve. However, there are some prescription medications that can be prescribed, which can cause a temporary raise in a dropping eyelid caused by Botox®. This can be helpful in camouflaging the eyelid droop until the Botox® effect resolves.

Another common complication resulting from poorly applied Botox® is illustrated by what happened to a former patient. This is a photo of her before and after her eyelid surgery with me in the past.

This is a photo of her after the Botox® treatment she received by another physician in which her right eye became very heavy following the treatment. She reported that the treatment reversed the nice lift I had previously achieved for her.

When inexperienced Botox® practitioners try to smooth all the forehead lines with Botox® and don’t understand why those lines are there to begin with, they inadvertently cause the eyebrows to collapse into the eyelid space and make those lids look very heavy. When I see forehead lines, I treat the cause of those lines and not the effect. I treat the eyebrow muscle depressors and this can cause the brows to raise-up. Then and only then do I proceed to treat the forehead lines very carefully.

Other complications occur due to the spread of the Botox® from the intended muscle into neighboring areas. Although rare, Botox® use near the crows feet area can result in double vision. In the lower face, Botox® can be used to smooth lines in the upper and lower lips and to turn the corner of the mouth upwards.

Botox® use in the lower face requires exquisite knowledge of the anatomy and is only recommended for expert Botox® injectors. Otherwise, problems moving the lips and mouth can result.

Botox® is truly a wonderful treatment for many types of facial cosmetic issues. But, it is of the utmost importance to identify the qualifications and level of experience of your injector. In general, the more experience someone has, the better injector they usually become. Possessing a background in facial anatomy and aesthetics along with valuable experience tends to result in the best outcomes for patients.

Cheap Botox® On-the-Go: What do you think?

I read this newspaper article in the St. Petersburg Times on Sunday and thought it would be a good topic to discuss with people reading my blog: Low-cost Botox® treatments raise some eyebrows.

Please take a look and let me know what you think. Is it okay to receive a medical procedure in a spa, gym, or even the mall? I’d love to read your responses to the article.

To learn more about how you can safely and effectively rejuvenate your facial appearance through Botox Tampa or non-surgical face lift Tampa, Contact Our Office.

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