Botox is a very safe and effective anti-aging treatment. However, it must be used with care, and each patient needs careful evaluation to determine the optimal site for their injections and the appropriate dose. Therefore, botox treatment can fail if it is administered in the wrong place or if it is administered too much or too little. Knowing precisely where to give it and where not to give it, and the proper dose, requires expert training and a very thorough understanding of anatomy, as well as an awareness of the potential risks of inaccurate injection. Although distressing, the effects of failed Botox treatment are almost always temporary (the exception would be an extreme overdose that could be fatal) and will go away on its own within 3-5 months.

Give the injection in the wrong place and the wrong muscle groups will be paralyzed for the next four to six months. This can cause temporary facial disfigurement, such as drooping of an eyelid (on one or both sides) or drooping on one side of the face or mouth. For droopy eyelids, there is a prescription eye drop medication called Lopidine that helps a little, although it must be used several times a day.

Using too much Botox around the lips can cause impaired lip function and not being able to eat properly as the mouth cannot seal properly around a cup or spoon. If Botox is used improperly around the neck, swallowing difficulties and hoarseness can occur. This is a serious complication that may mean the need to support the patient with nasogastric feeding until the effect of the Botox wears off.

Eyebrow and eyelid drooping after botox is usually caused by inexperienced providers who fail to assess the forehead and forehead muscles correctly. There is no specific treatment for this other than waiting. The next Botox treatment will need to be given at a lower dose, higher up on the forehead, or a combination of the two.

If too much Botox is administered, it can lead to a plastic, unnatural, or frozen appearance. Some people like that, but most would prefer a more subtle, natural look that allows for some facial expression. If too little is given, you will see very little improvement in your appearance and the effects will wear off faster than the usual three to five months you have to wait. If your Botox has been messed up with very little effect, you should talk to your provider. Most good quality providers take before and after photos and provide the opportunity for a review two weeks after treatment. This is a good time to raise these concerns.

The risks of failed Botox can be reduced by asking the following questions of your provider:
– What is your training and experience? Were they trained by an accredited institution? How many patients do you see each week? If your provider sees only one or two each week, it’s unlikely you’ll be able to develop or maintain your Botox skills.

– What kind of continuous evaluation and revalidation system is governed? If you are seeing a doctor in the UK, you can be sure that they must undergo an annual assessment and demonstrate an audit of their work.

– Can they tell you what their complication rate is? any practitioner who is direct and honest will admit that things go wrong from time to time, and he will be able to tell you how often they do.

– What kind of botulinum toxin do you use? The main types are Botox, Azzalure (Dysport) and Xeomin. Botox and Xeomin units are bioequivalent (meaning equal strength), but Azzalure is not as potent, unit for unit, as Botox or Xeomin. Therefore, additional units of Azzalure (2.5-3 times more) are needed to get the same effect as the same units of Xeomin or Botox. If your provider is using Azzalure, ask how many units you will receive and what the equivalent dose of Botox would be. Treatment results with Azzalure are at least as good as with Botox (some studies even report a longer duration of effect with Azzalure), but you need to make sure the dosage is appropriate.

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