As the popularity of Botox continues to grow at an exponential rate, so too does the incidence of side effects and mistakes that can come along with incorrect injection technique. Fortunately,  Botox is quite safe and most side effects can be corrected or are temporary. I am an Allergan certified Botox and Juvederm instructor and help many patients overcome their Botox side effects or mistakes.

uneven brows from botched botox injections
Botched botox injections

1. Pain, swelling, or bruising at the site of injection: this is the most common Botox side effect and can generally be avoided. Make certain that you do not take blood thinning medications like NSAIDS like Advil for at least a week prior to your injections. Certain herbals such as garlic, St Johns wort and Vitamin E should also be avoided.

I use cold packs before and after injection, pressure at the injection site, and micro needles to prevent these side effects.

2. Uneven facial features: during the first 7-10 days after Botox injection, different muscle groups can be affected at different rates which can lead to the face looking uneven. For example, in this photo you can see that the left brow is 1-2 mm higher than the right brow. If this persists beyond 10 days, a very tiny amount of Botox can be injected into the muscle pulling the left brow upward to correct the problem.

3. Drooping eyelid:  this can be one of the most frustrating Botox side effects, but fortunately this occurs less than 1% of the time. If the Botox placed over the eyes diffuses downward, it can effect the muscle that opens the eyelid. The technical term for this is ptosis.

This is not a permanent complication and can often be helped by using a special eye drop which activates the eyelid muscle.

I avoid this side effect by mixing my Botox at a high concentration which means I need to inject less volume and can put the product exactly where I want it without worry for diffusion. I also use a careful technique, avoiding injecting along the bone over the eye known as the orbit.

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For more information on Botox side effects and correction of common mistakes, please see my website.

If you are pregnant, nursing, or trying to become pregnant, check with a board certified surgeon or dermatologist before proceeding with Botox injection.

This is not a comprehensive list, but a summary of the most common Botox side effects. For full prescribing information please see the official Botox safety information.