3 Common Mistakes When Injecting The Botulinum Toxin

Botox is one of the most commonly requested procedures today, and it has earned a reputation as a ‘lunchtime treatment’- a fast, efficient, and safe procedure that’s very quick and simple to carry out. However, as a form of facial injectable, mistakes can be costly, which is why botulinum toxin should only be administered by highly trained professionals who take the time and effort to ensure optimal results for patients.

Many wonder about what happens if an injection misses the muscle. You can read this article to learn about botox danger zones, botox injection site diagrams and masseter botox gone wrong.

Here are 3 common mistakes when injecting botulinum toxin which could result in poor outcomes for your patients:

1. Injecting Botulinum Toxin Into the Wrong Muscle

Many of the muscles in the face are located very close together, which is why Botulinum toxin procedures may go wrong, especially when they are performed by those without a competent level of Botox training.

In fact, the frontalis muscle actually overlaps the corrugator muscle, resting over the corrugator medially yet underneath it laterally. This can make it tricky to inject the corrugator supercilii muscle without affecting the frontalis.

Unfortunately, injecting the frontalis can result in the ‘Mephisto Effect’, leaving the tails of the brows upturned at a very sharp angle. Expert precision is required to target the correct muscle. A similar situation can occur if the orbicularis oris is injected instead of the intended depressor septi, with some patients unable to properly move their upper lip if this happens.

2. Injecting Too Deep

There are some areas of the face where injection of botulinum toxin should be made superficially only, targeting the part of the muscle that lies just underneath the skin. For example, when injecting into the orbicularis oculi around the eyes — an effective method of treating crow’s feet and creating a larger eye appearance — delivering the toxin too deeply can result in a highly raised brow and an unnatural look. Instead, it is more effective to inject this area superficially. This can also minimise post-procedure bruising for the patient. Another facial muscle that should be injected superficially is the orbicularis oris, where a deep injection technique could affect the patient’s speech.

3. Injecting Too Superficially

While injecting the botulinum toxin too deeply is a common mistake, so is injecting it too superficially. This problem is most often seen when targeting the masseter muscle near the mouth, which is responsible for chewing. As the risorius muscle sits above the masseter, if the toxin is not delivered deeply enough, the risorius can be affected, resulting in an uneven smile. Even if the masseter muscle is reached, failure to inject deeply enough can leave the lower parts of the muscle moving as normal while the top part is relaxed, creating a ‘chipmunk’ appearance. Practitioners should aim to inject at the site where the muscle meets the bone, using a longer ½” needle for best results.