Bad Botox happens, but there’s simply not enough information out there on what it looks like and what to do about it. It’s even harder to speak the same language as your injector when they toss around words like “corrugator and frontalis” and you’re thinking, “I dunno, I just don’t want to look like Dr. Spock”.
I know from personal experience which I shared in “10 Things I Wish I Knew Before I Got Botox“, that it’s all to easy for things to go wrong, or more commonly, just not all that right.
Dr. Brandith Irwin, the creator of Skin Tour.com, one of my favorite to sources for all things dermatology demystified talks about what makes or breaks Botox;
With Botox, there is the great, the good, the ugly.
Great Botox is customized to your individual face, taking into account factors such as which facial muscles you use the most, your facial muscle balance from side to side (we all have asymmetries), your job, your social life, and the look you want (for example, natural or high glam (my word for frozen). Great Botox requires steady hands, the eye of an artist, and the passion to get it perfect. Great Botox injectors can be hard to find.
Good Botox is where you get the standard four or five shots into your frown lines and you go on your way. It works perfectly well, but there’s not much customization. And the range of looks that these injectors can accomplish is limited. But if you have only some frown lines, good Botox can work just fine for you.
Ugly Botox is all too common. You’ve seen it on television: it’s that completely unnatural frozen look, or worse, where the poor person almost looks like she’s had a stroke, one side of her face completely different than the other. The point is, Botox is not a cookie-cutter procedure. In the hands of a good injector, it can create a marvelously natural look that makes you more refreshed- and relaxed-looking. In my opinion, the goal of Botox is no wrinkles, not no movement.
In the spirit of making it a little easier to reach Botox nirvana, I used celebrities to illustrate what bad Botox looks like. Not to throw rotten tomatoes their way, but rather reinforce the point that if people who’s livelihood depends on their looks and have access to the best resources can have bad Botox, it can happen to you too.
1. Suddenly Sinister: The Evil, Arched Brow
You know the look; it’s the hyper arched eyebrows with the outer third pulled too high towards the ears that make that make women look like they’re up to no good. This typically happens when only the center of the forehead is injected (or over injected), causing the area between your brows (medial brow) to drop down and the outside portion of your brows (lateral) to remain high. Fortunately, there’s often something your doctor can do. According to Dr. Brandith Irwin,
“A good injector can usually prevent this. This can also be fixed rather easily and quickly (usually at no charge) with a few strategically placed drops of Botox to relax the muscle that’s pulling the eyebrow up too high. Don’t suffer in silence, go to your doctor and ask him or her to fix it for you.”
What’s interesting about this is that it’s while I reference Dr. Spock to dramatize my point, it’s usually just a millimeter of difference that makes the difference between great Botox and “meh” Botox. For example, look at Nicole Kidman; when examined up close, she doesn’t look so bad, but there’s something just slightly off that detracts from the beautiful woman she is. That’s sub-par Botox.
2. The Quizzical Brow
Another version of this is when one brow is arched more than the other. This usually happens when the Botox is either unevenly applied, or your natural asymmetry is underestimated (usually the case), which is why the eye and hand of the injector is so important. Again, this is something can often be corrected so get your butt back to your doctor for some fixin’ (at no charge).
3. The Iron Forehead, Low Brow
Reportedly one of the most common Botox mistakes, this is when the forehead looks ironed, immobile and your brows are a little lowered. It can also feel like someone is sitting on your forehead, especially in the first few weeks. This happens when too much Botox is injected into the frontalis muscle, which runs across the length of the forehead and connects to the eyebrow movement. Your forehead relaxes, but so do your eyebrows, which can make them feel heavy and droopy. This effect is exaggerated even more in people who already have some “hooding” (excess skin) on their upper eyelids because subconsciously they raise their eyebrows more in order to make their eyes open wider.
“If the doctor doesn’t correctly perceive how much the patient uses this muscle (the frontalis), then too much Botox will cause the upper eyelid skin to look more hooded.” Says Dr. Irwin.
Unfortunately, the only solution here is Father Time.
4. The Deep Freeze
One thing I love about Botox is that I always look calm under pressure because my little stress furrows between my brows are gone. But in the spirit of chasing youth and glamour, some women take it too far and wind up erasing a lot of the small facial expressions that make them look human. Usually this happens with too much Botox in the forehead as mentioned above, but can be compounded by liberal use in the crow’s feet around the eyes or too much and around the mouth. Dr. Irwin who calls this look the “Oscar Night Freeze” due to the amount of celebrities who consume Botox the way they do coconut water. Like with the “ironed forehead, low brow”, the only solution is to wait it out.
5. Eye Lid Droop (Dana Delaney, Simon Cowell)
Dana Delaney bravely admitted this happened to her after a perfectly reputable doctor hit a nerve causing her eyelid to droop. Even though this created a lot of buzz, it’s actually very rare. Most of the time, heavy or droopy lids are a result of the “ironed forehead, low brow”. Sadly, in Dana Delaney’s rare case the nerve that the doctor hit was permanently damaged, although she looks perfectly fine now. For most though, time will usually be the cure, although there are eyedrops you can have your doctor prescribe such as apracclonidine, brimonidine or neosynephrine hydrochloride to help elevate the lid while it wears off.
6. Droopy Smile (Teri Hatcher)
Most injectors prefer Botox in the upper third of the face, but there are some who are experimenting with the lower face, in areas such as the vertical wrinkles above the upper lip among others, although the results are mixed. This is an area where you need to be very careful and confident in the experience of your injector. Not sure I would let a doctor or nurse you’re not familiar with inject you here for your first time. If your smile looks slightly flattened and lopsided, the solution is likely time, but in some cases it may be a simple case of balancing out the other side. High tail it back to your doctor for their opinion.
7. Puffy, Crepey Eyelids
There are rare cases where when Botox is injected too low into the crows feet area and migrates into to the lower eyelid, making it look puffy and crepey. Unfortunately, this is often the result of an inexperienced or unqualified injector as the there are millimeters of difference between the injectable areas and no fly zones on the face. If this happens and you want immediate solutions, Fraxel and Thermage are reported to help, but they aren’t cheap. Speak to your doctor about whether you’re a good candidate for Botox of the crows feet if this has this effect. Otherwise, time heals usually heals all.
The good news in most of this is that even if you have a scary encounter with bad Botox, it’s temporary. I’ve also found, that even though Botox lasts 3-5 months, the errors soften in about 6 weeks. The not so good news is that it’s harder than it should be to find a skilled injector. Rule of thumb is to start out with a board certified cosmetic plastic surgeon or cosmetic dermatologist, and in some states NPs and PAs who are part of a doctor supervised cosmetic practice.
Where this gets tricky is that the best injector isn’t necessarily the plastic surgeon just because they can do more stuff. It’s the injector with at least 5 years of Botox experience and the “eye, hand and talent” to visualize the end result. It’s the injector who can think beyond the wrinkle and judge the impact a millimeter here and there can make on your beauty.
And while I’ve never personally used Dr. Irwin, I can tell you from experience that this video is exactly what your Botox appointment should look like. She evaluates your face, knows where to inject based on your facial musculature and takes her time.