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

Leonard Grossman, MD · Answer

I have never heard of anyone using 1.25 units of Botox. The amount is so small I don't think that it would even touch a mosquito. Good luck from New York City

Alex Eshaghian, MD, PhD · Answer

Thank you for your question and for sharing your
photograph sarahbella21. I understand your concern. Botox is a purified protein
used to address wrinkles associated with facial expression. When injected into
the skin Botox will relax the muscles and smoothen out the overlying wrinkles. The
most common areas of treatment are in the upper face. These include the
horizontal lines seen on the upper forehead when one raises the brows, the
vertical lines seen between the brows when one frowns (frown lines), and the
crow's feet seen around the eyes when one smiles.It is difficult to make an assessment without a
formal exam in the office where I can view the skin in multiple angles and observe
wrinkles formed with facial expression. However, I hope the information
provided here is useful.The pivotal studies used 20 units of Botox in
the glabella area between the brow to address the frown lines. These studies
demonstrated that the peak results are seen 14 days after the treatment and
most people enjoy their results for 3-4 months. At that point, a maintenance
treatment is recommended. While some people start to see results as early as
the next day, it can take two weeks for full results so patience is
important. We have our patients return two weeks after their treatment to
assess their results via photographs. At that time additional units may be
added if necessary. The pivotal studies used 24 units of Botox (12
units per side) to address the crow’s feet. These studies demonstrated that the
peak results are seen 14 days after the treatment and most people enjoy their
results for 3-4 months. At that point, a maintenance treatment is recommended. While
some people start to see results as early as the next day, it can take two
weeks for full results so patience is important. We have our patients return two
weeks after their treatment to assess their results via photographs. At that
time additional units may be added if necessary. Many people are concerned about how their
appearance will change after a Botox treatment. This is understandable given
the amount of both positive and negative publicity there has been around Botox
and other cosmetic treatments. When done properly, Botox will provide a natural
appearance that makes a person look more youthful and rested. With the increase
in popularity of Botox treatments many offices now provide such treatments. It
is important to find an office where the injector has experience and expertise
in Botox injections. I recommend looking for experience, before and after
photographs, and testimonials.When Botox is used to treat the crow's feet around the eyes, if the product is placed too low, it can spread to the nearby zygomaticus muscles, which are responsible for raising the corners of the mouth when a person smiles. If these muscles are inadvertently relaxed from the Botox it may lead to the appearance of a temporary asymmetric smile. I have found that low doses such as 1-2 units are not sufficient to lead to a significant deficit, and even in such an event it would not last very long.With any injection, there are risks such as
pain, bleeding, bruising, redness, swelling, tenderness, and infection. We take
special precautions to minimize these risks such as using a painless technique.
We also treat bruises with a laser as early as the next day. Bruises usually
resolve within two weeks if untreated. After a laser treatment bruises usually
resolve in 1-3 days, but may still take two weeks for full resolution. In
addition to these risks, with Botox there is also a risk that the product spreads
or diffuses to nearby structures. Spread to nearby muscles can lead to side
effects such as the temporary appearance of droopy eyelids or a temporary
asymmetric smile.After a Botox treatment, I recommend that my
patients avoid heat exposure, alcohol consumption, and strenuous exercise for
24 hours and not lie down flat for four hours. This is because all of these
activities may possibly lead to the movement of the product and consequent side
effects such as droopy eyelids as described above. Although there have been no
definitive studies shown that these actually occur and some physicians do not
provide such aftercare instructions, in the absence of data I err on the side
of caution and recommend that my patients avoid such activities.Please consult with a doctor for specific
recommendations. Good luck!

Ramtin Massoudi, MD - Account Suspended · Answer

Hi Dear Sarah Bella
I would not worry right now, I don't think you are going to have an issue
But I would recommend filler rather than botox in general.
Thank you for great question
Ramtin Massoudi, MD

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

Answers (8)

More Botox Questions

WE SEND PRETTY
EMAILS

Answers (8)

More Botox Questions

I was wondering if botox or another injection can help with bruxism?

Headache after Botox. Is that normal?

How long to wait before getting more Botox after unsatisfactory results?

Masseter botox 5 weeks ago, but there is no change in my face shape. Does this mean that my jaw bone is making my face square?

Myasthenia gravis and Botox alternative other then fillers that are available?

WE SEND PRETTY EMAILS

WE SEND PRETTY
EMAILS