Botox & Botulinum Toxin
If this live bacteria enters the bloodstream, it will attach itself to muscles and replicate, weakening or completely immobilizing the muscle.
However, when it is not performed properly, Botox can result in a "frozen" or fake look. The most common causes of botched Botox are: Improper injection techniques. Many unskilled injectors make the mistake of injecting Botox too deeply or too superficially into the skin.
Bruising may occur if an artery or blood vessel has become blocked due to filler injection. Bruising may range from a blue discoloration to a dusky purple-grey appearance. Swelling is likely to occur in and around the injection site if vascular obstruction is present, and may range from mild to severe.
Vascular occlusion during dermal filler treatment is rare. It is, however, a serious complication that can quickly lead to tissue necrosis if not identified and treated promptly.
The two primary diagnostic symptoms of vascular occlusion are pain and changes in skin color. Immediate, severe, and disproportionate pain and acute onset of color changes – blanching (or white spots/blotches) – are an indication of arterial occlusion.
This occurs if the VO is not picked up, usually around 2-3 days post injury. The compromised skin has begun to die due to lack of nutrients and oxygen downstream from the blocked vessel.
Intra-arterial drug injection may cause vessel injury by one of several mechanisms. The vessel may be obstructed by inert particles or drug crystals. Hemolysis, platelet aggregation, vasospasm and venous thrombosis are the other contributory factors . All this leads to acute thrombosis of the artery.
Injecting too deep
For example, when injecting into the orbicularis oculi around the eyes — an effective method of treating crows feet and creating a larger eye appearance — delivering the toxin too deeply can result in a highly raised brow and an unnatural look.
It's very common for any type of injection in the face, not just Botox/Dysport, to cause temporary dilation of the veins in the area. This usually lasts 20-60 minutes.
“'Some telltale signs of 'Bad Botox' are asymmetry of facial movement, excessive brow elevation and unnatural brow shape, noticeable upper-eyelid hooding, a 'frozen' look, and some lines getting smoother and others looking exaggerated,” explains New York facial plastic surgeon Konstantin Vasyukevich, MD, who offers ...
Too much Botox in the forehead muscles can cause the eyebrows to droop, making the upper eyelids look very heavy and hooded. The face may look angry or sad all the time. Too much Botox around the eyes can dramatically affect facial expression. The face is simply frozen.
Botox must be injected into the superficial layers of the skin in some areas, while in others, it needs to be injected deeply. One example is the masseter muscle near the mouth. If a practitioner doesn't inject this muscle deeply enough, patients can end up with an uneven or unbalanced smile.
Even the best physicians can cause a patient to bruise after administering BOTOX. It often occurs when the needle knicks a blood vessel, allowing blood to leak below the skin's surface and causing the surface to appear reddish and/or purple.
Botox toxins are thought to remain active in the body or target area for 4 to 6 months before being metabolized and excreted from the body.
The main symptoms of botulism patients included headache, dizziness, insomnia, fatigue, blurred vision, eye opening difficulty, slurred speech, dysphagia, bucking, constipation, and anxiety. These clinical symptoms occurred 0∼36 days after BoNT injection, especially from 2nd to 6th day after the operation.
You can make a follow up appointment with your provider, and they might be able to fix things. But in many cases, the best thing to do is to wait things out. There's no enzyme that can reverse Botox, so it might just be that you have to wait for it to wear off.
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.
The frontalis is injected either intramuscularly or superficially just under the subcutaneous tissues. In general, injection is performed at least 1.5 cm above the superior orbital rim to prevent ptosis.
It is extremely unlikely that you'll hit a blood vessel, and the practice of aspiration is now discouraged by the Centers for Disease Control and Prevention for injecting vaccines. However, aspiration is still recommended for medications that would be dangerous to inject into the blood vessel.
Signs of suspected arterial puncture include noting bright red blood with pulsatile flow, blood column moving upwards in the tubing of an infusion set, intense pain and distal ischaemia.  Confirmation is carried out by blood gas analysis, pressure transducer and ultrasound.
Puncture of an artery may be more uncomfortable than puncture of a vein. This is because arteries are deeper than veins. Arteries also have thicker walls and have more nerves. When the needle is inserted, there may be some discomfort or pain.
Retinal vein occlusion is one of the most common blinding conditions in the United States; without treatment, central retinal vein occlusion (CRVO), the most severe type of retinal vein occlusion often leads to significant and permanent vision loss.
With proper care and healing most occlusions heal with almost no trace - although it does take a long time.
“A key difference is that bruising will have a normal capillary refill time, whereas a VO will have a delayed capillary refill,” Dr Jaymi advises as the best way to determine bruising from vascular occlusion. “Capillary refill time is a simple bedside measure to check peripheral tissue perfusion.