How To Deal With Bad Botox & Facial Fillers

Four days after I got filler and neuromodulator injections, I was looking at myself in the mirror as I did my skin care routine when I realized that something was... off. Rather than the subtle smoothing that I’m used to post-appointment, I was left with more asymmetry than I had before; my chin was a bit lumpy, my smile was uneven, and the right side of my face looked higher overall.

Getting your face, of all things, tweaked by way of hyaluronic acid filler or neuromodulators like Botox does put you in a vulnerable spot. You’re entrusting someone to inject either a muscle-paralyzing toxin or a plumping molecule into your moneymaker. Do it just a fraction of a centimeter off or in the wrong spot, and you can wind up with an unnatural or undesired look — or something more serious, like necrosis (the death of tissue).

Much like winning the lottery and getting struck by lightning, facial injection complications are the kind of thing that seems improbable. I definitely thought so, especially as a beauty editor who has access to the most elite dermatologists and plastic surgeons out there. But I was wrong. While my tweakment results weren’t dire, they affected my appearance and therefore my self-esteem, so I frantically booked an appointment with Dr. Paul Jarrod Frank, a top cosmetic dermatologist based in New York City, for help.

Ahead, here’s everything you need to know about dealing with tweakments gone wrong.

The Risks Of Botox & Filler

To be clear, Botox and hyaluronic acid filler are generally considered safe, nonsurgical cosmetic procedures. And they’re done constantly: According to the Plastic Surgery Statistics Report, over 4.4 million neurotoxin injections and 3.4 filler injections were performed in the U.S. in 2020. (And those numbers have undoubtedly gone up since then.) Still, botulinum toxins are highly poisonous — so, although serious side effects are super rare, it shouldn’t be lost on you that the injections should only be done by board-certified professionals.

“The worst thing that can really happen [with neuromodulators] is if it’s injected in the wrong spot and it relaxes muscles that you don’t want to relax, which can cause a droopy eye or something of that nature,” says Frank. (This is what happened to me with Daxxify.) More commonly, you can be left with a poor aesthetic outcome. “Not understanding the musculature of the face and the variations between different individuals, face shapes, and ages can lead to poor injection technique and aesthetic problems such as uneven eyebrows, smaller eyes, or a surprised look,” notes Frank. You can also experience bruising, which is quite common, but this can be largely prevented by icing the area before and after the injections.

Common side effects of hyaluronic acid filler include bruising, swelling, and some pain and tenderness, which go away within a few days. You may also experience vascular occlusion, but this is your worst-case scenario. In mild cases, this involves redness (erythema). But, as Frank explains, it can lead to the lack of oxygen and eventual death of tissue in the injection site (in this case, the skin would turn black). This is extremely rare, though. “If managed well, it can be prevented,” notes Frank. You’re much more likely to be left with aesthetic imperfections and an unnatural look, which Frank says typically comes from inexperienced injectors — and that’s when you might consider dissolving your filler.

What To Do When You’re Not Happy With Your Facial Injections

If you need to dissolve filler or want to check in with a different practitioner about undesirable neuromodulator results, you’ll want to book an appointment with a board-certified dermatologist or plastic surgeon who has specific training in these injectables. A good one will be as well-versed in injections as they are in handling mistakes. When I sat down in Dr. Frank’s chair a week after my original appointment elsewhere, I quickly learned that I was far from the first person he’s seen in a scenario like this. “I would say about 15% of my patients that come to me have either had complications or poor aesthetic outcomes and are looking for greater expertise,” he tells me.

Most of the time, bad injections will resolve themselves with time — especially if it’s the neurotoxin results that you’re unhappy with. “Sometimes, you can make adjustments by manipulating surrounding muscles, but other times, you just have to wait for things to wear off. That can be anywhere from one to four months,” says Frank.

I learned that I didn’t have as bad of an aesthetic outcome as I thought. I figured that my asymmetry was due to the chin filler that I got, but Frank said it was actually from the neuromodulator Daxxify and where it was injected. “Neuromodulators placed on the upper face can actually affect the smile, because the orbicularis oculi muscle here is connected to one of the zygomatic muscles that go to the corner of the mouth,” Frank explains. So, while some people post-filler and neuromodulators think their puffed-up cheeks or crooked smile are from the filler, it’s actually the latter. “If you come too low [with a neuromodulator] and try too hard to get the little crinkles around the eyes, it can affect the smile and symmetry of the face,” he says. “That’s why being very conservative on this lower injection is so important.”

Since my crooked smile was from the neuromodulator, I simply had to wait it out. “This will wear out in a week or two,” says Frank. In other situations, one might want to get other injectables to balance things out, he notes, but that wasn’t the case for me.

Dissolving Filler

Frank did notice that my chin filler was lumpy, so he used Vitrase (hyaluronidase) to dissolve it. Hyaluronidase is an enzyme that breaks down hyaluronic acid and is used for correcting bad filler jobs. “You inject this where you feel a lump or want to dissolve the filler,” says Frank. “You’ll feel it soften in as early as an hour or up to a day.” As he injected my chin, I barely felt a pinch — it’s a similar sensation to getting Botox.

The side effects of hyaluronidase injections are basically the same as getting filler: You might experience bruising or swelling. I experienced neither, and my chin looked like its former smooth self within a few hours.

On average, hyaluronidase injections can range anywhere from $750 to $2,000, according to Frank. “It can then be an additional cost for reinjection,” he says.

Avoiding Bad Injections

Clearly bad injections can happen to anyone — even if you go to a board-certified professional. While you can’t necessarily prevent them, you can visit the right practitioner right away to rectify the situation. “The real definition of a good physician is knowing, when lightning strikes, how to deal when things go wrong,” says Frank. So while you may not be a candidate for Botched, do your research and hunt down a derm or plastic surgeon who has years of experience. “You should ask them how many times a day they perform injections,” Frank advises. “If they go by week or month, know they don’t have significant experience.”

Studies referenced:

Beer, K. (2012). A Treatment Protocol for Vascular Occlusion from Particulate Soft Tissue Augmentation. The Journal of Clinical and Aesthetic Dermatology, 5(5), 44-47. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3366448/

Jung, H. (2020). Hyaluronidase: An overview of its properties, applications, and side effects. Archives of Plastic Surgery, 47(4), 297-300. https://doi.org/10.5999/aps.2020.00752

Witmanowski, H. (2020). The whole truth about botulinum toxin – a review. Advances in Dermatology and Allergology/Postȩpy Dermatologii i Alergologii, 37(6), 853-861. https://doi.org/10.5114/ada.2019.82795

Experts:

Dr. Paul Jarrod Frank, board-certified cosmetic dermatologist and founder of PFRANKMD