I got 200 units of Botox in my face 2 weeks ago for muscle spasms. That side is now completely paralyzed (Photo)

This is a large amount of botox for the face and would cause muscle paralysis.  it would stop the spasm but will affect the cosmetic results.  I suggest you speak to your injector.  Best, Dr. Emer.

Thank you for your question. I understand you received 200 units of Botox for facial spasms, and now the right side of your face has become paralyzed and you state it feels like cement.

To give you a little about my background — I am a Board-certified cosmetic surgeon and a Fellowship-trained oculofacial plastic and reconstructive surgeon, practicing in Manhattan and Long Island for over 20 years. I have worked with Botox for quite some time now — since 1993. Neurologists and ophthalmologists were one of the first groups of doctors to first use Botox in their practices.

Before it was used for cosmetic purposes, Botox was considered an orphan drug, or a drug with limited application for very specific neurologic conditions, such as blepharospasms and hemifacial spasms. In the absence of a physical exam, I will venture a conjecture that your condition is possibly a hemifacial spasm.

A hemifacial spasm is a condition wherein the muscles contract uncontrollably, in a way that causes discomfort, pain, and affects normal movement. I would suspect the doctor who is treating you currently is probably one who has been treating you for a long time. In my practice, patients who I treat for blepharospasms have very thick records because they come in on a regular basis to get Botox injections, and have done so for quite some time. It is not unusual to go through 100 units of Botox to treat, for example, benign essential blepharospasm for both eyes. With regard to hemifacial spasms, a bit more finesse is required in order to avoid situations of overcorrecting.

Botox is a temporary treatment, and the effects of this will eventually dissipate, however I would advise you to get in touch with your doctor as soon as possible. When you have a relative overcorrection like this, for all intents and purposes, you’re dealing with facial nerve palsy. What is concerning about this is the eye exposure. When nerves are paralyzed in a way that makes you unable to fully blink your eye, your eye becomes exposed to environmental stressors that can affect the health and integrity of your eyes - the eye may become dry, the corneal epithelium can be compromised, and in worst-case scenarios  the eye can become infected. To make sure that this doesn’t happen, get in touch with your doctor or see an ophthalmologist and ask for advice on how you can protect your eyes with the help of artificial tears, ointment, or tape.

In terms of levels of functionality, you are going to face the same challenges as someone who has Bell’s palsy, someone who’s had a stroke, or someone who’s had facial nerve paralysis. These challenges also include oral function. Ultimately, you will certainly still need to meet with your doctor to discuss these concerns, but know that within a couple of months, the Botox will wear off. What is important right now is to maintain the health and functionality of critical areas, and from my perspective, that would be the eyes.

I hope that was helpful and I wish you the best of luck!

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Dear Lee,Thank you very much for your question and also for your photo.  I am very sorry to hear that you have such severe muscle spasms that you require Botox.  This is an excellent medication for treatment of muscle spasm, but unfortunately too much Botox has been placed to treat your muscle spasms and you are now left with the results of muscle weakness.  Fortunately this will all resolve in approximately 3-4 months.  You shouldn't see improvements over the next 2 months as well.  It is important that you make certain that your eye closes all the way and that you do not have any eye irritation or eye problems.  Further, I recommend that you contact your provider to review the treatment that was given.  I would also recommend using a lower dosage in the future.  Hopefully this is helpful to you.Be healthy and
be well, James M.
Ridgway, MD, FACS