Botox is a common minimally invasive anti-aging treatment often used for wrinkle reduction and facial slimming. However, during injection, deviations in positioning, depth, dosage, or asymmetry between sides can lead to a series of adverse reactions. These may include unnatural facial expressions and mild cosmetic effects. In severe cases, temporary vision impairment may occur, impacting daily life.
Below we analyze the complications that may arise from improper botulinum toxin injection during wrinkle reduction and how to address them:
1. Difficulty Opening Eyes
Cause: The frontalis muscle is the primary upward-contracting muscle in the forehead. Injection can weaken its lifting force, causing eyebrows to droop. This side effect is unavoidable but can be minimized.
Treatment:
① Wait patiently for a period of time;
② Apply local heat therapy, steam baths, or engage in regular exercise (after the recovery period) to boost basal metabolic rate;
③ Use neostigmine or neostigmine eye drops for partial relief;
④ Apply 0.2% epinephrine eye drops continuously for 10 days, 3-5 times daily.
2. Lower Eyelid Ptosis
Causes: Injecting too far inward when treating crow's feet wrinkles, or administering excessive filler volume when treating lower eyelid lines. This relaxes the orbicularis oculi muscle, exacerbating the appearance of eye bags. Severe cases may develop ptotic lower eyelid ectropion.
Treatment:
① Wait patiently for a period of time;
② Apply local heat therapy, steam sauna, or engage in regular exercise (after the recovery period) to boost basal metabolic rate.Over-injection or deep placement in forehead lines or glabellar lines may also affect extraocular muscles, causing symptoms like blurred vision, focusing difficulties, double vision, photophobia with tearing, and pupil dilation.③ For severe photophobia, wear sunglasses and minimize eye strain; ④ Use neostigmine or neostigmine hydrobromide eye drops for potential relief; ⑤ Apply 0.2% epinephrine eye drops continuously for 10 days, 3-5 times daily.
4. Facial distortion or unnatural expressions
Causes: Complex distribution of facial expression muscles. Incorrect injection sites, bilateral asymmetry (in dosage, location, or depth), or excessive volume causing diffusion into surrounding muscles may result in facial stiffness, abnormal contractions, or asymmetry—most commonly a crooked smile.
Treatment:
① Wait patiently for a period of time;② For mild symptoms, prioritize psychological counseling;
③ Apply local heat therapy, sauna sessions, or increase regular exercise (post-recovery period) to boost basal metabolic rate;
④ On the side with normal or slightly hyperactive muscle tone, identify the optimal counterbalance point and perform a small, trial injection of higher-concentration botulinum toxin;
⑤ Strictly adhere to the principle of "less is better than more."5. Difficulty closing the lips Cause: The mentalis muscle is the only muscle pulling the lower lip upward. During normal lip closure, it remains relaxed; contraction occurs during pursing or pouting motions.When excessive botulinum toxin is injected into the mentalis muscle or the injection site is too high, the toxin may spread into the orbicularis oris muscle area. This can cause difficulty closing the lips, involuntary drooling, and a foreign body sensation in the lower gum area.