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Why does your botox shot go bad? Is it a safe procedure?

Botox is very safe when done by a trained cosmetologist, is more than just a beauty treatment and has wider medical benefits, says Dr Sonali Kohli, Consultant Dermatologist and Venereologist, Sir H N Reliance Foundation Hospital and Research Centre

Botox is an outpatient procedure with minimum to no downtime. (Representational/File)

Written by Dr Sonali Kohli

Over the last decade, botox has infamously got its position only as a cosmetic agent used to freeze your look. However, Botulinum Toxin (botox) is a neurotoxin that is injected in your muscles to relax them and its one indication has been for relaxing of facial muscles to ease fine and dynamic wrinkles.

The first thing to highlight about botox is that it always does the same thing no matter where it’s injected. It is derived from a bacterium called Clostridium botulinum, which is the most potent toxin known to man. One of the bacterium’s main effects is to cause temporary paralysis of muscle, and that property is harnessed for medical purposes. The substance is injected into the body, where it blocks nerve endings from absorbing certain molecules they need to work properly. The diversity of its uses comes not from the substance itself, but how different fields use its properties to a patient’s advantage.

It has been mostly used for anti-ageing as it eliminates frown lines and crow’s feet (wrinkles around the eyes). However now it is popularly being used for a procedure called Nefertiti lift, named after ancient Egyptian Queen Nefertiti, known for her elongated, thin neck. In this procedure the platysmal bands on the neck and lower jawline are injected to prevent sagging.

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Botox is an outpatient procedure with minimum to no downtime. It should be done by a trained aesthetic dermatologist or plastic surgeon in a clean sterile setup. If done by a trained physician, it can yield very aesthetic and natural-looking results. The crucial knowledge concerns how much botox is required for what tissue and for what purpose. When injected in the wrong muscle, a botox procedure can go bad. For example when done on the forehead lines, an inexperienced hand could inject it into the muscle that is supposed to lift the eye brow. In excess amounts, that can lead to a contrary effect resulting in an eye spasm. And if you keep going overboard in a certain area repeatedly, without reviewing it thoroughly with a trained cosmetic surgeon, then the muscles could naturally weaken over time. So for normal facial expressions, your body begins using other muscles on the face, making you look odd when you smile or emote. Besides, botox procedures are allowed only in certain parts of the face. If you apply the same routine elsewhere on your face or any other body part where it is not meant to, there will be adverse reactions.

The side effects of botox, if not injected by an experienced and trained physician, include a frozen look, eyelid spasm or lip drool. These side effects are rare and reversible. It is important to bear in mind that botox actions are temporary and last only four to six months after which it is flushed out of the system. Usually any side effect or aberration goes away in two months.

Due to certain over injected faces, the popularity of botox was wrongly advocated and has led to fears for the same treatment. However, at length discussion with your primary aesthetic physician can help ease these concerns. Understanding the outcomes and required dosage and results in depth can help ease these doubts.



It is actually a clinically proven safe procedure with minimum to no downtime for the patient. That’s why it is often referred to as a lunch-time procedure as the patient can return to their daily activities immediately post the procedure.

It is done for both men and women with similar indications and yields youthful appearance in all. Newer trends in botox are of very small unit injections called micro botox, which are very popular in the younger age group. In this procedure, micro units of botox are injected into the muscle to decrease the muscle activity and help define and enhance contours of the face. They are also used to treat smokers’ lines, peri orbital wrinkles for a more youthful pout and lip appearance.

No genuine practitioner would ever recommend a procedure without checking the patient’s age, medical condition and purpose. One certainly shouldn’t go for it at a young age.



The original use of botox was for treatment of crossed eyes (Strabismus) from where its effects or surrounding periorbital wrinkles were first noted and initiated its use in cosmetics. It is US FDA-approved for several other conditions in individuals 18 years or older like:-

First published on: 18-11-2022 at 15:41 IST
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