My Friend Has Too Much Botox. What Do I Say?



We’ve all seen it – the friend whose cosmetic treatment has changed their facial appearance, and not for the better. What do we do, when we want to say “You’ve had too much Botox,” while looking at their frozen face or puffy lips and cheeks out of proportion with the rest of their features? The answer, nothing, do not comment, unless you are asked for your opinion or your friend opens the door for feedback, announcing they are receiving treatments. Most importantly, before you say anything, know that Botox is very rarely the cause of significant changes in the face, facial oddities after treatment are almost always the result of surgery or overcorrection with hyaluronic acids (HA) fillers like Juvederm or Restylane.

What, you say how can this be? The explanation is simple; Botox is a muscle relaxer, it does not stretch or create puffiness in facial features, it only relaxes them. In my over 20 years’ experience in the field of aesthetic medicine, it has been extremely rare for me to see facial oddities due to Botox. In my opinion, these oddities are almost always related to surgery which stretches the skin or overcorrection with hyaluronic acid fillers which cause puffiness under the skin.

During surgical procedures like facelifts, eye lifts, or fat transfers, a person’s skin is cut and stretched permanently changing its position. With each successive procedure, the repeated cutting and stretching of the skin changes the shape of the face. Now more than ever this kind of facial distortion is unnecessary; with the significant advancements in injectable fillers, surgical options can usually be avoided.

Filler treatment must be performed with the right kind of fillers; the second most common reason people look different after treatment is overuse of Hyaluronic acid (HA) fillers. HA fillers are the most popular choice of physicians because they are among the easiest to work with, dissolve quickly and look good right after injection. HA fillers, however, are gels, and over time they hold water; creating a puffy effect. With each additional syringe of filler applied more water is retained, and the face gets rounder and more distorted. To avoid this, work with a provider who emphasizes the firm fillers like Radiesse or Sculptra, which do not retain water and provide more natural results.

Cosmetic injections are an art form; the artistry is in knowing how to inject fillers, so the face looks younger and rested. The result of successful treatment, your friends noticing your natural youthful appearance shining through without knowing you have had anything done. To achieve this find an experienced provider, ideally one whose entire practice is dedicated to the injectable arts. I dedicate my practice to aesthetics medicine, and when planning an Eyerise or BaseLift treatment, I evaluate how the treatment will affect the entire face, not just the areas I am injecting. During treatment I use firm fillers, along with limited amounts of the HA type fillers; so ultimately my clients leave my studio looking untouched with their natural youthful appearance restored.

Verve Medical Cosmetics
New York Office
240 E. 60th Street
New York, NY 10022

P: 212.888.3003

New Jersey Office
66 NJ-17
Paramus, NJ 07652

P: 201.226.9009


Verve Medical Cosmetics
240 E. 60th St New York, NY 10022
(212) 888-3003
Hours: Mon 8:30am - 6pm
Tue 8.30am - 6pm
Wed 8:30am - 7pm
Thur 8:30am - 6pm
Fri 8:30am - 6pm
Sat 10am - 2pm
66 NJ-17 Paramus, NJ 07652
(201) 226-9009
Hours: Tue 10am – 6pm
Thur 10am - 1pm

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