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BOTOX Side Effects and Complications


                                              Woman receiving BOTOX Cosmetic

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The most common side effect of BOTOX treatment is temporary bruising. Another side effect is headaches; however this is a rare occurrence. If headaches do occur, they are usually gone within 24 to 48 hours.

The most common side effects from BOTOX include:

BOTOX should not be given with patients who have certain neuromuscular disorders such as ALS, myasthenia gravis, or Lambert-Eaton syndrome – as they might be at an increased risk of serious side effects.


BOTOX Complications


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As with every procedure, there will be a certain amount of risks or complications that might occur. 





Occasionally there are cases of incomplete muscle paralysis of the injected muscles, leading to an irregular contour upon frowning or raising ones eyebrows – which could mimic swelling. This is either due to inadequate dosing of the BOTOX, or incomplete area of the muscle injected. Swelling in general with injections of BOTOX is unusual; however you might get slight swelling at the injection sites for a few hours.

Patients may develop a small hematoma (bruise) at or near the injection site. Hematoma is the result of the needle injuring a small blood vessel and will also resolve within 1-2 weeks. In order for a hematoma not to happen, physicians will tell their patients to be off of all anti-inflammatory medications and aspirin products two weeks prior to any injections to minimize the risk of bruising.





Normally this means that a capillary or a vein has been hit with the injection needle, causing a delayed bruised.  When a superficial artery or vein is punctured this is a possible outcome.


Patients are advised about taking certain medications that might lead to "thinning of the blood", such as:

Patients are also advised not to work out or do excessive physical exercise immediately following your injections.


The anatomy of the tear trough area can make the hematoma or a bruise appear worse. The skin of that area can be very thin and show uneven injections or hematomas more easily and for a longer period.


If after several weeks the bruising does not go away, sometimes IPL - Intense Pulse Laser which is an non-invasive laser treatment, is recommended.  This IPL Laser helps capillaries and bruising by breaking up the old blood that might be left behind in the tissue of the skin.


Read Medication to Avoid




You should have BOTOX and fillers injected by cosmetically trained specialists (plastic surgeon, facial plastic surgeon, dermatologist, and oculoplastic surgeon); as they have a very good understanding of the anatomy of the antagonistic muscle pairs in the face.

Too much BOTOX or even a little in the wrong place can cause your eyebrows to droop. If the BOTOX is placed too low on the forehead or injected into the wrong muscle group, the muscle that raises the forehead (frontalis) will be inactivated and not able to lift the brow.  A droopy brow can look like a droopy lid.

If you do get a droopy eye from BOTOX, some physicians are using Alphagan and Iopidine to correct the situation.  It is considered safe and the only contraindication is use of a (MAO) monoamine oxidase inhibitor.  Alphagan works by stimulating a second set of muscles called Muller's muscle which causes lifting of the eyelid muscle.

Lopidine (Apraclonidine) Eye Drops mode of action is that it goes to work on a tiny muscle in your eyelid and help pull it up 1 to 3 mm. The drops must be repeated a few times a day for a continued effect. If you have drooping eyebrows leading to full eyelids, these eye drops will have no effect.



                                   Where BOTOX can be injected safely


                       Illustration from the textbook Baumann L. "Cosmetic Dermatology: Principles and Practice"

                                                            McGraw Hill, Philadelphia, March 2002.


                             Injections in this "Danger Zone" can cause a droopy eyelid








BOTOX Competition:

  • Medicis Pharmaceutical Corporation, the maker of Restylane and Perlane, has marketed a new Botulinum toxin A product called Dysport. This product has just received FDA approval. Dysport will now compete directly with BOTOX in the United States market.

  • Mentor Corporation is investigating another Botulinum toxin A product under the name PurTox. It is not known when this product will reach the market.

  • There is also a Botulinum toxin B product available in the United States under the name Myobloc and elsewhere as NeuroBloc. This product is distributed by Solstice Neurosciences and is primarily used for medical conditions and not cosmetically.

  • In France, Allergan markets BOTOX Cosmetic under the name Vistabel.





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