Can 1.25 units of Botox improperly injected into upper cheek area (too low on the crows feet), cause smile paralysis? (photos)

Question

2 weeks ago I got 20 - 24 units divided between forehead and the 11’s + 2.5 units in each crows foot area. This “softened” everything but there is definitely still motion. Touched up yesterday with 1.25 units under each eye (middle of the crinkles), and1.25 in each “lower crow’s feet” area (more like the cheek area). I’m SO WORRIED about smile paralysis. Don’t see any signs yet (24 hours later), but please ease my mind and tell me 1.25 units won’t do much even if she DID hit the wrong spot?

Julia Ann Sullivan Miller, MD · Answer

1.25 units is a small amount of Botox and will not likely cause any problems.  However, if you do develop any unwanted effects, they will wear off in the next few months.

Nicholas Gentry, MD · Answer

Average crows feet dose is 6-12 units each side. Even if injected too low, I don’t think 1.25 units would do anything at all. I have never injected such a small amount anywhere.

Kurt Kuhlman, DO · Answer

Small doses of Botox can cause smile paralysis if enough is injected in the correct area. 1.25 units is a very small amount and even if injected intentionally into the smile muscles, it would probably cause minimal weakness for a few weeks. Additionally, your injector would have to place the Botox about an inch under your eye at or below the cheekbone to paralize the smile muscles.

Kristin J. Tarbet, MD, FACS · Answer

Hi and thank you for your question. First of all the average injection for crows feet is 6 to 12 units, more in men. I can't imagine 1.25 units of Botox doing much of anything...very small dose, unless it was injected under the lower lids. You can impact the muscles supporting the lower face if one were to inject outside the normal injection zones or utilizing extra large does. Good luck

Melvin Elson, MD · Answer

Are you sure you got this amount? it is very small and diffiicult to even measure but if so there is little chance of a problem with the smile. be sure you are seeing a board certified dermatologist

Can 1.25 units of Botox improperly injected into upper cheek area (too low on the crows feet), cause smile paralysis? (photos)

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Can 1.25 units of Botox improperly injected into upper cheek area (too low on the crows feet), cause smile paralysis? (photos)

Answers (8)

Answer: Botox??

Answer: Botox??

Answer: Botox under eyes with 1.25 units

Answer: Botox under eyes with 1.25 units

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Recommended reading

Everything you need to know about Botox

Our mission is to create a world where every investment in modern beauty is Worth It.