The risks of Botox injections are very small, but as with any other medical or cosmetic treatment, things can go wrong. Redness, bruising, bleeding, or swelling may occur. If the injection of Botox results in an uneven (asymmetrical) appearance, it can be corrected quickly. Consulting a doctor who can inject more Botox on the stronger side is the best solution.
Some patients have bags under the eyes due to fat herniation or fluid retention. In this case, injection of botulinum toxin can worsen these bags if the lower fibers of the orbicular muscle of the eye are excessively relaxed. Therefore, in patients with a tendency to develop bags under the eyes, injection into the lower part of the crow's feet should be avoided in order to preserve the tone of the corresponding region of the ocular orbicular muscle. This action can lead to ptosis of the eyebrows or eyelids.
It has been observed in many patients older than 65 years of age or older who use the frontal muscle to keep their eyes open. Relaxation of the frontal muscle in these patients can lead to ptosis of the eyebrows or eyelids. Therefore, when injecting botulinum toxin into these patients, it is important for doctors to carefully examine whether the patient uses the frontal muscle to open his eyes or not. If yes, injection should be avoided in that case.
In order to achieve more natural results and use a smaller amount of botulinum toxin, physicians should be familiar with the basic contraction patterns of the glabella13—15, forehead,16, and crow's feet17 and customize the injection pattern for each patient. Asymmetrical features, drooping eyelids or even a “Spock eyebrow” are signs that your Botox has been misinjected and should look as natural as possible. Doctors who try to inject the superciliary corrugator muscle often inject the lower part of the frontal muscle, causing the medial part of the forehead to descend and the lateral part of the forehead to arch upward unnaturally, generating a Mephisto effect. This effect is temporary and after a few months, relaxed muscles retain their tension and a new injection is required.
Combining botulinum toxin with other cosmetic treatments provides excellent overall results and doctors should explain this to patients. Using generic values to make calculations can cause an issue with eyebrows, so it is important for doctors to use authentic Botox to ensure natural results. If you think your Botox appointment didn't give you desired results, wait 10-14 days for treatment to begin fully before consulting a doctor. Even if masseter muscle is reached, lack of deep enough injection can cause lower parts of muscle to move normally while upper part is relaxed, creating a “squirrel” appearance.