Being a common treatment outcome of botulinum toxin procedures, its important to understand the possible reasons for it to occur.

• Anatomical and natural structure already has asymmetry. Generally speaking everyone will have imbalance in the their facial features to some degree, this is completely normal. This can sometimes be highlighted with the use of injectable toxins but was there already before treatment.
• Even with the best planned and well executed treatments, you cannot account or pre-empt a patient’s deeper anatomy such as asymmetry in; muscle size, receptor density, fat, or bone shape.
• Perfect treatment again, however the dose of toxin delivered to the motor end plates can end up being uneven. This will be explained further through the module.
• Delivery of treatment may have been asymmetrical via dosage or injection points, causing a problem
• The patient suffers from body dysmorphia which is causing an exaggerated response to a very small aesthetic asymmetry.

Body dysmorphia is usually related to a fixation of something small in someone’s appearance, that wouldn’t be noticed by a different patient, not suffering from such a condition. They will become extremely distressed by a very small physical attribute of themselves giving a disproportionate response emotionally. Be aware of these patients, they may take this feeling out on you as their injector and try to blame and hold you accountable. Correct approach and patient management is key in diffusing any uncomfortable situations, while working in the best interests of your patient.