The most popular cosmetic treatment in the world, hands down? Botox. Year over year, for two decades running, botulinum toxins have topped the nonsurgical charts, repeatedly proving their vast appeal across demographics.
Injectable neuromodulators—the OG Botox along with Dysport, Xeomin, Jeuveau, and Daxxify—have become so ubiquitous, so seemingly breezy and routine, that we sometimes forget that these purified poisons can carry serious consequences. For a poignant reminder, look no further than TikTok, where the hashtag “Botox gone wrong” has more than 11 million views. From droopy eyelids and Spock brows to golf ball–like masseters and wonky smiles, the app provides copious evidence of the risks associated with neurotoxins.
“There are many reasons an undesired result can occur from neurotoxin treatment,” says Washington, D.C., board-certified dermatologist Dr. Noëlle Sherber. And not every flub is instantly fixable. “When there’s still [muscle] movement remaining after a toxin treatment, then some adjustment can be made by injecting additional units in precise anatomic areas, to counterbalance the existing result,” Dr. Sherber says. “But if the muscles are quite frozen, then often the best approach is to give the results time to fade.”
How much time? Usually at least a few weeks—possibly longer if you’ve been treated with Daxxify, a supercharged neuromodulator shown to perform for about six months. “With this longer-lasting toxin, the stakes have been raised,” notes Dr. Laurel Geraghty, a board-certified dermatologist in Medford, Oregon. “Proper technique and advanced training matter even more.” While Daxxify complications haven’t been shown to outlast those resulting from other neuromodulators, “it would be such a bummer to fall victim to an untrained provider who commits you to a bad cosmetic result for a full six months,” she says.
Ahead, top dermatologists and plastic surgeons weigh in on some classic examples of Botox gone wrong and how to avoid them.
Droopy eyelids
Chicago influencer Whitney Buha put botched Botox on the public radar in 2021 when she posted about her dramatically droopy eyelid (or ptosis)—the result of a misplaced needle stick. According to Dr. Sarmela Sunder, a board-certified facial plastic surgeon in Beverly Hills, California, drooped lids, especially of this magnitude, are pretty rare. “I’ve never seen anything that significant in person,” she says, referring to Buha’s situation.
Dr. Geraghty agrees, noting that studies show ptosis can happen about 2–4% of the time. However, she adds, “it can almost always be avoided with proper injection technique.”
Mild cases can sometimes be improved with prescription eye drops, like Upneeq, which work to stimulate the Muller’s muscle of the upper eyelid, elevating it by one to three millimeters. “That often does the trick for a couple of weeks until the toxin wears off and the lid goes back to normal,” says Dr. Sunder. In select cases, “you can also place Botox in the eyelid in a strategic location, to get the lid lifted, but you really have to know what you’re doing, because you risk dropping the lid further if you put it in the wrong place.”
People with more considerable eyelid sag may have to wait for the effects of the toxin to wane in order to regain proper lid function.
Asymmetrical, or “Spock” brows
More typical toxin hiccups include asymmetric or peaked eyebrows, which can happen if you treat the glabella (in between the eyebrows) and/or crow’s-feet but fail to address the frontalis muscle in the forehead, says Dr. Jason D. Bloom, a board-certified facial plastic surgeon in Bryn Mawr, Pennsylvania. “That unopposed pulling of the frontalis can lift the brow too high,” he explains. There’s an easy fix for it, thankfully: “If you put a drop of toxin at the brow peak, it allows that muscle to weaken and helps settle things down,” he says.
While a Spock brow is always a risk with toxins, says Dr. Geraghty, “I ask my patients never to live with it, since a quick touch-up fixes the problem.”
Heavy brow
Another relatively common complication is the heavy, hard-to-lift brow that comes from “receiving too much toxin, for that particular patient, in the frontalis,” says Dr. Bloom. Currently, Botox is the only neuromodulator that’s officially FDA approved for the forehead, with an on-label dose of 20 units. But our experts say this is more than the average patient needs. Dr. Bloom generally uses 8 to 10 units in the forehead “because the frontalis is very sensitive to toxin and it’s the only lifter of your eyebrows,” he says. “The more you weaken it, the less you can lift your brows.” Overtreating that muscle makes the brow sit lower and feel heavier than it ordinarily would—and “women, especially, tend to hate that,” notes Dr. Bloom.
Dr. Geraghty finds older patients (the 70-plus set) to be particularly prone to heaviness. “They rely on their frontalis to lift the brows and open the eyes, so if we drop this key muscle, the brows become smoother but also heavier,” she explains. “I lower the dose in my older patients, to help avoid a heavy brow or hooded eyes. We want a lift—not a drop—and botulinum toxin injections have the potential to go either way, depending on a patient’s age, natural anatomy, forehead strength and tone, natural facial expressions, gender, and other variables.”
Interestingly, Dysport may be more likely to cause heaviness, since it spreads more than other neurotoxins, according to Dr. Karan Lal, a board-certified dermatologist in Scottsdale, Arizona. He also notes that “patients with smaller foreheads are more apt to experience a heavy brow sensation if toxin is placed liberally in the forehead.”
Unfortunately, there is no easy fix for an overdosed brow. “A tincture of time is really the only thing that’s going to help in these cases,” Dr. Sunder says.
It “didn’t take”
On the flip side, “some people come in saying that they received Botox elsewhere and it ‘didn’t take,’” Dr. Sunder shares. “Ninety-nine percent of the time, it’s due to undertreatment—they didn’t receive the necessary number of units.” She finds this typically happens if a patient says up front that they want to spend only a certain amount of money or when they’re aiming for a supernatural effect.
Dr. Sherber points to the “the dose-response relationship” when discussing this problem with patients. “In general, the more units injected in a given area, the more dramatic the result and the longer it will take to fade away as the muscle regains strength,” she explains. “When I’ve seen patients treated elsewhere who say their toxin is lasting only a few weeks, it can relate to inadequate dosing. Sometimes this even ties in with the reconstitution of the product, as injectors can excessively dilute toxins as a cost-saving measure.”
Botulinum toxin resistance can occur, Dr. Sunder adds, but it’s very rare: “I’ve seen two patients out of over 20,000 in my entire career who have true resistance.”
Masseter bulge
Search “jaw Botox gone wrong,” and you’ll find countless TikTokers flaunting this Botox blunder as if it were a party trick, comparing their bulges to “gills” and laughing at the absurdity of it all.
The masseters, or chewing muscles, are among the largest and strongest muscles in the face. They have both a deep portion and a superficial portion. People commonly get their masseters injected with Botox to ease clenching, grinding, and TMJ discomfort. A careful dose can also help atrophy the masseters slightly over time in order to slim the lower face, softening a square jaw.
But occasionally, things go awry. “When you have bulging, it’s often because either not enough units were used or the whole muscle complex wasn’t targeted,” Dr. Lal explains. “Sometimes only the deep part of the muscle gets injected, leaving the superficial portion unopposed—which allows it to contract and bulge.” Luckily, he notes, “this can easily be fixed with a superficial injection of more toxin.”
Lip lift malfunction
You can easily find folks on social media regretting their lip flips, but it’s not always due to a bona fide complication. In some cases, the toxin is simply doing its job, weakening the muscles around the mouth to evert the top lip and/or relax the “barcode lines” above it. If it works a little too hard though, “you can’t kiss normally, whistle, or use a straw properly, and you might struggle to sip from a cup without dribbling,” says Dr. Geraghty. When performing a lip lift, “the dose needs to be kept low, to help minimize the risk of weakness around the mouth,” she adds. “If a patient has functional impairment from Botox around the lip, I’ll drop the dose or won’t do it at all anymore. It’s not worth it—no one wants to look like they have Bell’s palsy or had a stroke.”
A strained smile
If you’re left with an unnatural, Stepford smile post-Botox, your injector probably went after your crow’s-feet a little too hard. “This was Nicole Kidman a few years ago—perhaps a bit too smooth around the eyes,” Dr. Geraghty says. The expression lines that form here are an integral part of a genuine (or Duchenne) smile—that whole-face, “love you, mean it” sort of expression.
When aiming to soften or prevent crow’s-feet, doctors inject the orbicularis oculi, which is the circular muscle around the eye that contracts when we squint. For the most natural effect with Botox, adds Dr. Geraghty, you want to keep some natural lines around the eyes and preserve the upward motion of the cheek muscles when smiling, to “give that little happy crinkle and maintain a smiley-eyed look.” Ultraconservative doses of toxin are key.
How to avoid botched Botox
While Botox fails aren’t permanent, it’s always better to prevent problems than troubleshoot after the fact. Here, five ways to set yourself up for success.
1. Don’t price shop
“A lot of people shop for injectables based on price rather than quality,” Dr. Lal says. “The phrase ‘you get what you pay for’ is forever real in cosmetic medicine.” Find an experienced, well-trained injector (preferably a board-certified dermatologist, plastic surgeon, facial plastic surgeon, or oculoplastic surgeon). “Ask how often they do injections of this kind and how many years they’ve been doing injections,” advises Dr. Geraghty. “A lot of people who inject botulinum toxin have taken only a weekend course or online tutorial.”
Dr. Sherber recommends choosing an injector with a good track record of treating complications. “The person you’d want to see to manage a complication should be the person administering the treatment in the first place,” she says.
2. Stick with one injector
“It’s best to develop a relationship with one injector and to see them consistently,” according to Dr. Sherber. “When a patient presents for treatment after having been treated with toxin elsewhere, there can be inadvertent overtreatment or undertreatment as the new units are injected into previously treated areas.” If you do need to seek treatment from more than one doctor, be sure to make each aware of what the other is doing—“not only of how many units of which product were injected but the placement and amount at each injection point,” she says.
3. Consider the whole picture
Don’t take a point-and-shoot approach to Botox, Dr. Sherber says. Sometimes treating a single wrinkle or specific spot in isolation can cause hyperactivity of the muscles in adjacent areas, resulting in an unnatural effect.
4. Stay upright
“Don’t do yoga or inversions for four days after treatment, since this could raise the risk of lid droop,” Dr. Geraghty warns. “We don’t want the toxin drifting from where it was placed and potentially weakening a particular upper eyelid muscle.”
5. Time your touch-ups
If your injector asks you back for a touch-up a couple weeks after your appointment, accept the invite. Dr. Geraghty notes that going back in one to three weeks after your injection can help your doctor determine your ideal dose and allow them to fine-tune your outcome. “Adding a quick unit here or there can sometimes make a beautiful difference in the final result.”
Certain blips can even be fixed at this visit. “Asymmetry and masseter bulges are the main reasons we have patients come back for assessment two weeks after treatment,” notes Dr. Lal. If left untreated, “most complications improve slowly, on their own, over 6 to 12 weeks.”
Just don’t jump the gun. “Avoid going for a touch-up prior to one week following Botox, Dysport or Jeuveau—or sooner than three weeks after Daxxify—as the medication may still be kicking in,” Dr. Geraghty says. “If you do a touch-up too soon, you could overshoot your dose and wind up with a heavy-handed treatment.”
Botox-gone-wrong TikToks
Droopy lid:
@trphotographer Botox gone wrong#botox #botoxface #botoxfilter #botoxeye #droopyeye #droopyeyelids #droppyface #botoxprocedure #doctor #botoxclinic #fy #fypシ #viral ♬ original sound – Tatiana Rezende
Wonky smile:
@nicki_andrea HELPPPP MEEEEEE #botox #botched #greenscreen #botoxgonewrong ♬ original sound – Nicki Andrea
Jaw Botox gone wrong/masseter bulge:
@tamikarawson_ Don’t worry guys Botox only lasts 3 months phew 😅 #botox ♬ original sound – T-RAW
