When done correctly by a skilled professional, neurotoxins can deliver amazing results. But when things go wrong, it’s pretty evident that the outcome isn’t ideal. “Key signs of ‘Bad Botox’ include uneven facial movement, overly lifted brows or unnatural brow shapes, visible upper eyelid drooping, a stiff or ‘frozen’ appearance, and some wrinkles looking smoother while others appear more pronounced,” says Dr. Konstantin Vasyukevich, a facial plastic surgeon in New York. His top three tips: “Do your homework. Be clear about the results you want. Communicate your preferences clearly with the injector.”
Sign 1: You Didn’t Receive the Authentic Product.
First and foremost—and this cannot be emphasized enough—you should only trust an adequately trained expert for any kind of injectable treatment. The experience and credentials of your injector make a massive difference in the results you receive. It’s not just about the product but also the skill and precision with which it’s administered.
Troy, MI plastic surgeon Dr. Anthony Youn emphasizes that ensuring you’re getting authentic Botox or another FDA-approved neurotoxin is critical to both safety and effectiveness. One of the simplest ways to protect yourself is to ask your provider directly where the product was sourced. “Ask if the Botox was purchased directly from Allergan in the U.S.,” Youn suggests, noting that this is the most critical question. Providers who purchase Botox from unauthorized sources or use counterfeit products can’t guarantee the same safety or efficacy. It’s a red flag if your provider is vague about the origins of their product or hesitant to answer.
To further protect yourself, you can also do a bit of your own research. A quick search online can confirm whether the provider is listed on Allergan’s official website as a certified Botox provider. This list includes licensed practitioners who directly access genuine products and adhere to Allergan’s safety protocols.
Another proactive measure is to ask to see the vial before treatment. A legitimate injector should have no issue showing you the vial, and this step provides peace of mind that the product is genuine. All FDA-approved neurotoxins, such as Botox Cosmetic, Xeomin, Dysport, Jeuveau, and Daxxify, come with specific identifying markers: each vial will have both a lot number and an expiration date printed on it. If these details are missing or unclear, or the injector avoids showing you the vial, it’s a strong signal that something might be off.
Sign 2: You Went for Too “Good of a Deal.”
While everyone loves a bargain, Dr. Grossman advises caution when it comes to Botox or other injectables. Be wary of “special offers” or discounts that seem too good to be true because, in many cases, they probably are. “Maybe that practitioner isn’t using branded products,” he warns. A notorious example of this involved a chiropractor in Florida who injected counterfeit neurotoxin imported from China, sending patients to the ICU. When the price is meager, it can be a red flag that the product might not be legitimate or that the practitioner may be cutting corners. Discounts like these often mean the injector uses a one-size-fits-all approach rather than tailoring the treatment to your unique facial structure and needs.
New York dermatologist Dr. Jody A. Levine also cautions against going for the lowest injectable price. She highlights the growing number of people offering Botox injections without fully understanding the intricacies of facial anatomy or how Botox interacts with muscles. “There are many injectors who do not fully comprehend facial musculature and the science behind how Botox works,” she explains. This can result in uneven results, frozen expressions, or other undesirable effects.
Dr. Levine stresses that Botox should not be viewed as a product to bargain for like you would with other consumer goods. Instead, it should be seen as a medical procedure requiring skill, precision, and an understanding of how your facial muscles interact. Regarding your face, aiming for the best result is more important than finding the lowest price. You are investing in your appearance and well-being, and choosing an experienced, knowledgeable practitioner is crucial to achieving a natural, balanced result.
Sign 3: Your Injector Used a Template Approach for Injections
This issue can be subtle, but there are ways to prevent it. According to Santa Monica, CA, dermatologist Dr. Karyn Grossman, many injectors rely on a “template” approach when administering neurotoxins like Botox. “Neurotoxins, fillers, lasers, and surgery involve both science and art,” she explains. Unfortunately, some practitioners attend brief training sessions where they are taught to follow a standard template for injections. While this technique might work somewhat, it often leads to overly frozen or paralyzed muscles without considering each individual’s unique structure or muscle patterns. The result? Patients walk out with a stiff, mask-like appearance, which lacks the natural movement that makes Botox results more appealing.
So, how can you avoid this “template” trap? Dr. Grossman advises doing your homework before committing to any injector. One effective strategy is to look at the results of previous patients treated by the practitioner you’re considering. Do those patients have the natural look you aim for, or do they appear overly frozen? By observing the injector’s past work, you can gauge whether their technique aligns with your desired outcome. Another key is communication—discuss your goals with the practitioner and ensure they understand that you want a customized treatment based on your unique facial features, not a one-size-fits-all approach.
Sign 4: Your Injector Didn’t Tailor the Treatment to Your Individual Needs
There’s no “one-size-fits-all” solution for neurotoxins, and your injector should be treating you as an individual, not just another appointment on their schedule. Dr. Grossman emphasizes that each person’s face is unique; therefore, every Botox treatment should be tailored to your specific features. A skilled injector will take the time to carefully analyze your facial structure, assess your muscle movement, and gauge the strength of different muscles before determining where and how much Botox to inject. This ensures that the treatment not only smooths wrinkles but also maintains natural facial expressions and harmony.
Another vital aspect of personalized treatment is communication. A good injector will ask you questions about your goals and preferences. “Is the injector asking how you want to look?” Dr. Grossman asks. “Are they discussing the specific effects or results you’re hoping for? These are crucial questions.” Your provider should be as invested in your desired outcome as you are. Suppose your injector isn’t asking these questions or dismisses your input. In that case, it’s a sign that they may be following a generic approach that might not deliver the personalized results you’re after. The right practitioner will listen to your concerns and work with you to create a treatment plan that aligns with your vision.
Encino, CA plastic surgeon Dr. George Sanders also emphasizes the importance of trust in cosmetic treatments. He recommends sticking with providers you’ve worked with before, saying, “Go with who you know.” Having your Botox done at a familiar office where you’ve already had other successful procedures can offer peace of mind. Practitioners who have already earned your trust will likely go the extra mile to ensure your satisfaction and safety. They value their relationship with you as a patient and would never jeopardize that by cutting corners, such as using diluted or substandard Botox.
Additionally, a long-term relationship with a provider allows them to understand better your face and how it responds to treatments over time. This continuity of care is invaluable because Botox isn’t a one-time fix; it typically requires ongoing treatments to maintain optimal results. Returning to someone who knows your facial dynamics and history with injectables makes you more likely to receive consistent, high-quality results that evolve with your needs.
Sign 5: You Didn’t Look Natural While Resting
While “not looking natural” may sound vague, Scottsdale, AZ, facial plastic surgeon Dr. Kelly Bomer clarifies how this relates to neurotoxins: “My definition of ‘Bad Botox’ is when the results appear unnatural both at rest and during facial movement.” Botox should smooth out wrinkles while preserving natural facial expressions. Dr. Bomer emphasizes the importance of asking your injector about maintaining average brow elevation when raising your eyebrows and proper cheek elevation when smiling.
One of the most common signs of “Bad Botox” is the so-called “Spock Brow,” where the outer tail of the brow becomes unnaturally high and spiked while the inner brow hangs too low, creating an odd, exaggerated look. Similarly, suppose Botox is injected improperly around the crow’s-feet. In that case, it can result in a pattern that limits natural cheek movement, leading to hollow eyes and puffed-up “chipmunk cheeks” when smiling.
These issues can be avoided when injectors carefully assess your unique muscle movements and inject them to enhance your features rather than distort them.
Sign 6: Noticeable Changes in Your Brow Appearance
When it comes to Botox, even the most minor adjustment in the brow area can lead to noticeable changes. Dr. Kelly Bomer emphasizes that the position and movement of your eyebrows play a crucial role in how natural or unnatural your Botox results will look. If your lateral brow (the outer part) naturally lifts when you raise your eyebrows, and your injector skips injections in the forehead above this area, you could end up with the infamous “Spock Brow.” This happens when the tail of the brow arches too high and sharply, giving an exaggerated, almost cartoonish appearance, while the inner brow droops, creating an imbalance.
It’s important to understand that not everyone’s brows elevate laterally. For those whose brows don’t have this natural lift, injecting into the lateral forehead isn’t always necessary. The key is for the injector to assess each patient’s unique brow movement and muscle patterns. A cookie-cutter approach can lead to awkward results like the “Spock Brow” or uneven symmetry between the two brows. This highlights the importance of having an experienced injector tailoring the treatment based on your anatomy rather than following a generic protocol.
Moreover, Dr. Bomer explains that if you already have slightly hollow eyes, Botox in the wrong places can make this issue more pronounced. Specifically, injecting too close to the top of the cheek or around the side of the eye can cause your eyes to look even more sunken and, when smiling, can create an unnatural puffiness in your cheeks, often called “chipmunk cheeks.” This distortion of the face’s natural proportions can be pretty unflattering and is an easily avoidable issue with the proper technique.
To avoid these undesirable results, Dr. Bomer recommends focusing Botox injections around the lateral eye and above, targeting the area to gently lift the brow’s tail without impacting the cheeks or making the eyes look more hollow. This subtle lift can enhance the natural contours of your face, giving you a refreshed appearance without sacrificing movement or creating exaggerated effects.
Sign 7: Unexpected Changes in Your Mouth Appearance
While brows often clearly indicate a problem, Dr. Grossman points out that the mouth can also reveal signs of “Bad Botox.” If you notice that your eyebrows have dropped into your eyelashes, making you look ready for a “Star Trek” audition, or if your mouth appears drooping, these are red flags. “These are unfortunate effects that can happen due to incorrect placement or an overdosage of neurotoxins,” Dr. Grossman explains. Though these effects aren’t permanent, they can be incredibly uncomfortable and affect your appearance until the Botox wears off.
Mouth issues, such as a drooping or uneven smile, often occur when Botox is injected too close to the muscles that control the movement of your lips. This can affect your ability to express emotions naturally and may even interfere with speaking, eating, or drinking. Botox in this area requires precision, as even a tiny error can lead to noticeable imbalances. While these problems can correct themselves over time, they can be frustrating and embarrassing while they last.
To avoid these issues, choosing an injector with a deep understanding of facial anatomy is essential, particularly around delicate areas like the mouth.
Sign 8: You’re Experiencing an Adverse Reaction.
While Botox is generally considered a safe and minimally invasive procedure, adverse reactions can occasionally occur, and it’s important to recognize when something isn’t right. Dr. Youn stresses that any unusual or concerning symptoms following a Botox treatment, such as changes in vision, persistent or worsening pain, increasing swelling, or other unexpected side effects, should not be ignored. These symptoms may indicate an allergic reaction or an adverse response to the treatment, and it’s crucial to address them promptly by contacting your doctor.
Vision changes, for example, could indicate that the Botox has migrated to a nearby muscle group, affecting the muscles that control eye movement. This can result in drooping eyelids (ptosis) or even blurred or double vision. Similarly, if you experience excessive or prolonged swelling and pain, these could be signs of an infection or other complications related to the injections. While mild swelling, redness, or slight discomfort is expected in the first few hours after treatment, anything beyond that should be investigated further.
An allergic reaction, though rare, can also occur. Symptoms might include itching, hives, difficulty breathing, and severe warning signs requiring immediate medical attention. It’s essential to inform your injector of any known allergies before treatment and to report any unusual symptoms immediately if they arise afterward.
The key to managing any adverse reaction is prompt action. The earlier you address an issue with your healthcare provider, the better your chances are of minimizing any long-term effects and ensuring a safe recovery. While most Botox-related complications are temporary, they can be uncomfortable or even debilitating during the time they persist. This underscores the importance of working with a highly qualified and experienced injector who can minimize the risks of complications and provide the proper guidance and care if something goes wrong.
Sign 9: No Visible Results After Treatment
One of the most frustrating outcomes of a Botox treatment is noticing no visible difference after the procedure. Dr. Youn points out that while lousy side effects, such as those mentioned earlier, are clear signs of an issue, not seeing any improvement in your wrinkles after a week might also suggest that the Botox wasn’t practical or that you didn’t receive what you thought you were paying for. If your wrinkles remain unchanged after treatment, it’s worth considering whether the product used was genuine and properly administered or if other factors are at play.
However, it’s essential to be patient before jumping to conclusions. Dr. Bomer explains that Botox doesn’t produce immediate results, and it generally takes between seven to 14 days for the full effect to become apparent. For some individuals, it can take up to three weeks for the muscles to fully relax and for the wrinkles to smooth out. The delayed onset is a normal part of the Botox process, as it takes time for the neurotoxin to block the nerve signals that cause muscle contractions.
In some cases, patients may become concerned prematurely, thinking the treatment didn’t work simply because they aren’t seeing instant results. It’s essential to wait out this initial period to assess the effectiveness of Botox. If you still don’t notice any change after two to three weeks, it may indicate that the dose was too low, the product wasn’t injected correctly, or a counterfeit or diluted version was used.
Additionally, Dr. Bomer points out that it can be challenging to predict immediately whether the final result will look natural or unnatural after an injection. Sometimes, an injector may be too aggressive, leading to an overly “frozen” look once the Botox entirely takes effect.
Sign 10: New lines are forming
New lines can develop even after Botox, and Dr. Grossman explains why. “When one area is frozen too much with Botox, you can actually see new lines forming elsewhere,” she notes. This happens because when one muscle group is overly relaxed, other muscles may compensate by becoming more active, which can cause wrinkles in areas that weren’t previously affected. For instance, if the forehead is frozen too stiffly, the muscles around the eyes or lower face may overwork, leading to new lines in these areas.
While this can be alarming, the good news is that it’s not permanent. As Dr. Grossman explains, “If your provider has been heavy-handed, the effects will eventually wear off.” However, the downside is that the more aggressive the treatment, the longer it can take for the Botox to fade. Typically, Botox effects last around three to four months, but in cases where too much was used, the over-relaxed muscles may take even longer to regain their normal function, which means living with those new lines for an extended period.
Another long-term consequence of excessive Botox usage, especially in the upper face, is muscle atrophy. Repeated, high-dose Botox treatments can weaken the muscles over time, leading to a loss of muscle mass. While needing less Botox in the future might sound like a benefit, this muscle atrophy can have the opposite effect on facial aesthetics. Dr. Grossman explains that losing muscle volume can cause the skin to thin out, particularly in areas like the forehead, creating a shiny, overly smooth appearance. While the forehead may be wrinkle-free, the contrast with the rest of the face can be jarring. A thin-skinned, overly smooth forehead paired with deep lines in the lower face and around the mouth or eyes can actually make the overall face look older rather than rejuvenated.
This is especially concerning for patients who have been receiving Botox for many years. Over time, the repetitive use of large amounts of neurotoxins can cause more harm than good, as the muscles that give the face its natural contours and youthful fullness gradually diminish. It’s a delicate balance: too little Botox may not achieve the desired smoothing effect, but too much can lead to a loss of natural expression and, in the long run, a more aged appearance.
How to Correct Bad Injections
Dr. Lal emphasizes that prevention is the best approach to avoid bad Botox results: “Avoid cheap injections. If it sounds too good to be true, it absolutely is!” While prevention is ideal, if you’re already dealing with the aftermath of a poorly done injection, there are ways to correct it. His top advice for speeding up the recovery process? “Exercise your muscles!” Regular movement of the affected muscles can help your body metabolize the neurotoxin faster, potentially reducing the duration of unwanted effects.
For those who are experiencing heavy eyelids due to overly aggressive injections, Dr. Lal suggests speaking with your injector about apraclonidine. This medication can stimulate the eyelid muscles, helping to open the eyes wider while the Botox wears off. It can provide temporary relief and improve the appearance of drooping eyelids.
In more severe cases, such as true ptosis (a significant droop in one eyelid), Dr. Lal recommends seeking an expert specializing in tarsal injections. These specialized injections, administered directly into the eyelids, can help address a ptotic eye by lifting the affected lid, offering a more permanent solution until the effects of the neurotoxin diminish.
In summary, while correcting bad Botox may take time, there are ways to manage and improve the situation. By following these steps, you can accelerate the recovery process and address any specific issues caused by an incorrect injection.