Botox In All The Wrong Places: What You Should Know Before Getting Injected

By Dr. Robyn Gmyrek

It’s so common for first-time Botox patients to not know where exactly on their face to get injections. What are the best injection spots for your fine lines? What do you do for crow’s feet? Should you get Botox near your lips? What if your face looks frozen afterwards? To help answer my patients’ questions, I walk them through their customized treatment plan and explain everything they need to know prior to their treatment.

It’s important to remember that not all clinical injectors have extensive training. And depending on state laws, some practitioners have little to no training or experience. On the other hand, board-certified dermatologists are required to have years of extensive medical training. Plus, they must have a deep understanding of how the highly complex facial muscles, tissue, and nerves work together—right down to the molecular level. That’s why I recommend first-time Botox patients to consult with a board-certified dermatologist to ensure an effective and safe treatment.

If you’re considering Botox and want to know the basics of where to inject (and not inject) before you consult with an expert, below are some helpful starting points.

The injection area isn’t always the same as the problem area.
Many inexperienced injectors don’t understand that the problem area is not always the injection point. We all hear horror stories of Botox gone wrong, and often this is the result of improper placement. A practitioner really needs a full understanding of facial muscles to know where to inject Botox.

Botox is most effective on the upper part of the face.
Botox works anywhere on the face that you have a muscle—which is the entire face! But while Botox’s ability to relax or temporarily paralyze a muscle has a lot of great uses, it can also cause unwanted results.

Botox is most effective on the upper third of the face. Specifically, it’s most effective on the glabella area between the eyes and brows. It is also effective in treating the forehead muscles and crow’s feet, which occur on the sides of the eyes when you smile or squint.

The lower part of the face requires more caution.
The lower part of the face is more sensitive when it comes to injections, since weakening the muscles around and on the lips can cause difficulty speaking or puckering. So, while Botox can be somewhat effective in treating the lines of the lower face, its use is limited by the fact that it can alter movement of the cheeks and mouth. This can potentially create an asymmetric smile or lip movement. This is why Botox on the lower face should be done sparingly and cautiously by an experienced injector.

Most mistakes happen in the forehead. Sometimes it’s called the “Spock brow.”
Because most Botox injections are done in the upper third of the face, most mistakes occur in the forehead. If a patient has a heavy upper eyelid and too much Botox is injected into the forehead, the eyes can look sunken or tired. Also, if more Botox is injected into the middle of the forehead than on the sides, the result can be what some people call a “Spock brow.”

A good injector should know where to never inject.
A qualified, experienced injector should never inject the area near the orbital bone right above the pupil. If Botox is injected here, it can drift down toward the upper eyelid and cause an eyelid droop. This can last from weeks to even months.

I’ve mentioned a few of the basics of Botox injection placement, but there are so many more nuances to achieving the excellent cosmetic results you want! All of our doctors are Board-Certified to safely bring you to the desired clinical outcome.

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