Correcting Botched Botox®


Dr Toni Phillips, clinical directorDr Toni Phillips | Clinical Director | BDA, BACD & IAAFA

We’ve all heard the horror stories when it comes to Botox® and lip fillers, but what out of the headlines that you read is fact, and what is fiction?

As well as stories that are created to give you the ‘scare factor’, much of the bad press surrounding injectable enhancements comes from where clients have been treated by unqualified practitioners with low grade, or even illegal substances. However, the simple facts are that as long as you have done your research, are medically suitable, and have chosen a highly qualified and experienced medical professional to carry out your procedure, the risks of such enhancements are minute.

If you’ve still got doubts about Botox® and lip filler procedures and want truthful answers to your questions, keep reading! We’re here to reassure you that you are safe in the care of DestinationSkin, with the help of our Medical Director Dr Toni Phillips. With over 10 years’ experience in the aesthetics industry and helping people to look and feel their best, Dr Toni knows a thing or two about the real facts surrounding aesthetic treatments! So she’s on hand to explain all things Botox® and fillers, and show you what you can expect when it comes to side effects and correcting the enhancement if you’ve had a bad experience.

What are often the top concerns for people considering fillers or Botox®?PlusMinus

For the majority of individuals, Botox® is used to smooth out the skin and improve the appearance of fine lines and wrinkles by decreasing the action of a muscle.  However, we need to remember that muscles are often responsible for more than one action, and also work together with nearby muscles. Therefore, if this is not taken into consideration by the injector when treating the individual, problems with the resultant look can occur, as other muscles can also be affected. Common problems that are obvious when Botox has not been administered correctly are:

  • over arched eyebrows (the ‘surprised’ look)
  • flat eyebrows (which causes the eye lids to look and feel heavy)
  • eyelid ptosis (when the eyelid has been affected by the drift of Botox®, and is unable to open fully)
  • fake/dead smile (when the cheeks come up to smile but the eyes don’t move)
  • frozen face (no facial expressions can be made at all)

In the lower face, problems with Botox® can cause a lower lip droop, uneven smile, or inability to make the smile at all.

What side effects can occur after having fillers or Botox®, and how common are they?PlusMinus

As mentioned above, the main side effects that can occur with fillers or Botox® include over emphasis within certain areas of the face, lack of movement, and lack of facial symmetry, amongst others. Serious problems with dermal fillers are rare, but can include damage or blockage of a blood vessel which can lead to skin necrosis (destruction of the skin). This is serious and requires weeks/months of medical intervention to save the skin and hopefully avoid any permanent damage that may require surgery.

More commonly, badly placed fillers lead to unwanted lumps, uneven facial balance, lips that are too big, protrude, are too inflated or just don’t look like human lips anymore. It is also important to bear in mind that too much filler can lead to the ‘done’ look, which is often not anti-ageing and doesn’t result in giving a youthful look. A good Medical Injector should be able to comfortably discuss with their client when they believe they are having too much filler, and when they should stop treatment for a period of time before having any more. This is because it is the injector’s duty to keep the client’s best interests at the very forefront of their minds when administering such treatments, as they are responsible for the outcome, and therefore should not put the client at risk by continuing to administer product when the client clearly should not have anymore. Be wary of injectors who try to push more and more treatments without consideration for your welfare, as this could lead to poor treatments and adverse side effects down the line.

It is important to mention here that bruises and swelling are NOT serious adverse events. Bruising and swelling are common, temporary side effects of all injectable treatments, and can happen anytime a needle is inserted into the face. As injectors, we use various methods to minimise the chance of bruising, and often we can successfully avoid it. Swelling will usually subside in a few days, but a person’s individual response can mean that it lasts longer. As with all of the highly experienced Medical Injectors at DestinationSkin, your injector will always be on hand to advise you of what side affects you can expect following your treatment, and how best to deal with these should they arise, so you can be confident that what you are experiencing is normal, or how to tell if you are having an adverse reaction.

Allergic reactions have been reported but thankfully are not common. A serious allergic reaction which is called ‘anaphylaxis’ can happen instantly, and medical treatment for this will be administered in the clinic. A delayed allergic reaction can show up as a rash in the days following the filler procedure. The treatment for this is usually a simple anti-histamine (the type of medication you would take for hay fever).

On occasion, there may be a ‘delayed hypersensitivity’ reaction which can show up as a swelling 6 weeks to 3 months later. The treatment for this depends on the features of the swelling and may include the use of an antibiotic. We do not know why some people experience these reactions, but generally it is advised that filler is only used in small doses and infrequently if this has happened once.

What can be done to fix botched lip fillers?PlusMinus

A lip filler that has not been done well can appear as lumps, uneven lips, severe swelling/infection, or nodules. If the lip filler has only been administered a few times, it is possible to reverse the issue by dissolving the filler with an enzyme called hyaluronidase. A short period of recovery (2-6 weeks) is recommended before adding any new HA filler.

In the case of someone who has had lip fillers over many years, it is not always possible to achieve a perfect correction. This is because there has likely been the formation of scar tissue during the many times the filler has been injected. I would recommend that you only have your lip fillers with a properly trained injector (Doctor, Dentist or Nurse Prescriber) who has had the relevant training and understands the importance of protecting the lip tissue during these treatments. All of the Medical Injectors at DestinationSkin are either Doctors, Nurses or Dentists, and have not only had years of experience within the industry, but also undertake on going training to ensure they are continually improving, which has resulted in a highly loyal pool of clients for each of them.

If it is decided that hyaluronidase can be used to dissolve lip filler, the treatment is very quick and simple. Often the filler dissolves instantly and the result can been seen in a few minutes. Sometimes, it can take 12-24 hours to dissolve enough filler to make a difference and achieve a correction.

What can be done to fix Botox® or facial fillers?PlusMinus

If a Botox® treatment hasn’t worked well, Botox® can often be placed in different muscles to balance the effect (e.g. If the brows are overarched; or in lower face if the lip droops). The effect will take 4-10 days to see a correction. In cases where too much Botox® has been used (frozen face, flat/heavy brows, eyes that don’t smile) unfortunately it is a waiting game. There is no way to reverse the effect of Botox® and you just have to wait until it begins to wear off, which is typically 8-10 weeks.

For facial fillers it is much the same scenario as for lip fillers. Lumps can be addresses by using hyaluronidase, and this can also be used if too much filler has been used. In some cases, adding extra filler can improve a situation where the facial balance is not harmonious or there is unevenness. As with dissolving lip fillers, the results of this can be instant, or it can take up to 24 hours to notice a difference.

How long until someone can have treatment again after a correction is fixed?PlusMinus

After the use of hyaluronidase, I would recommend a short waiting period of 2-6 weeks before adding new HA filler. In some cases, if the correction needs to be done immediately, new HA filler can be used after 24 hours. If extra Botox® is used to correct an unsatisfactory result, this will take 4-10 days until the correction is visible.

Before opting for more treatment following a bad experience, it is important to consider whether this is the right thing for you to do, whether you have waited long enough since your last treatment, and who you choose to have the treatment done with. Ensure that you get honest and professional advice from someone that is fully qualified to be sure that the same thing does not happen again.

Dr Toni’s top tips for considering lip fillers and Botox procedures:PlusMinus

  1. Make sure you do your research and choose an experienced, appropriately trained practitioner. At DestinationSkin, all of our Medical Injectors are highly trained Doctors or Nurses with a broad range of aesthetic expertise. It is always worthwhile spending time to see which injector specialises in the treatments that you’re interested in as they will be highly skilled in performing the treatment.
  2. Don’t be tempted by cheap or cut rate clinics. Fillers and Botox® are complex treatments which require a highly level of expertise and knowledge to administer them correctly, as well as a safe clinical environment in which to perform them. As mentioned above, our Medical team are all highly trained in what they do, and therefore you cannot get the same level of expertise from low cost alternatives.
  3. Be honest about how you feel. Don’t worry about sounding vain, or feeling guilty about wanting some help. It’s ok to want to look and feel your best, and the more we know about what you’d like to achieve, the better we’ll be able to help you.

We hope Dr Toni’s advice and knowledge has now equipped you with the information you need to recognise the signs of poor quality injectors and low grade clinics. As well as knowing the signs to look out for to avoid nasty treatment experiences, we hope you’re now aware of what side effects are quite normal, and which you need to seek help with. Most importantly we hope you’re reassured that with DestinationSkin you will be in the safe hands of our team of expert Medical Injectors, who are trained in delivering the highest quality treatments in a safe and ethical manner, whilst upholding your very best interests at all times.

If you’re considering facial enhancements and would like further information or help with a recent experience you’ve had, please submit your query below and we’ll get back to you with our honest advice and support.

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