Is my Disfigured Face a "Common" Botox Occurrence? Or the Result of an Inexperienced Injector? (photo)

Question

I had recieved botox for over 2 years and LOVED the results. I recently went to a new injector (a 26 year old LPN) and had 21 units of botox injected. I STRESSED that I wanted no more than 15 units. My results are horrific. I am now being told by the injector that my results a "common" botox side effect and have NOTHING to do with techinique or over use. Please look at my before/after pictures and give an opinion. I will never use botox again if this is "common" rather than from inexperience.

Richard H. Tholen, MD, FACS · Answer

21 units would occur if 0.7cc of 2.5units per 0.1cc dilution was used. This is a "standard" dilution and dose, but your photo does NOT look like either a standard dose or a standard injection pattern result!

	If this is a "common" effect that your LPN injector sees, then she should be banned from performing any further injections. BTW, only physicians, PAs (physician's assistants), and RNs are legally allowed to perform injections in most if not all states.

	I suspect that you received an over-dosage (improper dilution), but I have never seen this degree of deformity in 10 years of Botox use, so I can't say definitively.

	Don't give up on Botox--Give up on that injector! Best wishes! Dr. Tholen

Ron Shelton, MD · Answer

The photograph on the right which appears to be the after photograph is not displaying any common side effect. I have never seen such a result from Botox and find it hard to describe anatomically knwoing what muscles are normally targeted. Possibly you have an unusual anatomical disribution of muscles in the glabella region or the technique was not quite correct for you.

	let the Botox wear off and see a board-certified dermatologist or plastic surgeon for an evaluation and possible retreatment. You should spend at lesat three if not four months to let it wear off prior to trying it again.

Jon E. Mendelsohn, MD, FACS · Answer

Very sorry you are having issues.

I am having trouble seeing the image.

Would it be possible to send another image with better lighting?

Very seldom see a bad result with Botox.

Kenneth D. Steinsapir, MD · Answer

This is not really that common. It also very much looks like your were treated with more BOTOX than you are being told. 21 units is a fairly small dose. You were really flattened by your treatment. It is possible to have the treatment rebalanced. You can research my micro droplet botox treatment to learn how this is done. This will wear off but it can take months and treatment results like this mess with facial feedback and can cause feeling of dysphoria and depression. Please stick with physician and surgeon injectors in the core aesthetic specialities: dermatology, plastic surgery, facial plastic surgery, oculoplastic surgery.

Matthew Bridges, MD, FACS · Answer

The after photo is a bit hard to figure out, but it appears that you have not only a severe bruise but also really lowered brows. I would disagree that this is a common side effect of Botox. I have never seen anything like that from Botox or Dysport. I would tend to blame technique over the amount used in this case. 21 units is not really an excessive amount for the "frowner" muscles.

Jeffrey Zwiren, MD · Answer

This is a result that would not be acceptable from an experienced physician who understands the muscular structure of the face and how to inject Botox. Personally I have never seen something like this.

Martie Gidon, MD, FRCPC, FAAD · Answer

If you have had Botox injections for over 2 years, you know that this is not a common side effect.  Consult an experienced dermatologist or plastic surgeon for advice.

Khaled El-Hoshy, MD · Answer

Dear Robert, The photo is quite dark. However, there seems to be drooping of the inner sides of the brows, more on the right side. It can possibly be improved with botox in the corrugator muscles. Maybe worth a try.

	As far as side effects in general, they are extremely uncommon. A lot of the sequele are related to the injection technique, rather than the medication itself.

Robert L. Kraft, MD, FACS · Answer

Unfortunately, the after photo is difficult to see.  However, let me say that there is no reason for anyone to have Botox injected by an LPN when the country is full of board certified plastic surgeons and dermatologists.  I strongly suggest that you see a qualified physician.  This is not a common side-effect.  Botox complications are certainly more prevalent when the injector is inexperienced and lacks appropriate training.

Darryl J. Blinski, MD · Answer

Photo after BOTOX hard to see underexposed. But you can read each expert believes this is not very commion effect. So lets look at the issues here. 1. Why have a non doctor inject a poison into you skin? Especially an LPN! Are you sure the injector was trained in any techniques? 2. Or what were you thinking? Was the price the determining factor? 3. Finally, the amounts injected vary between 10 to 25 units, most doctor injectors understand the dose/response data for BOTOX. Please respond so we all can see exactly what lead you to a non doctor injector .

Is my Disfigured Face a "Common" Botox Occurrence? Or the Result of an Inexperienced Injector? (photo)

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