How to avoid side-effects with Botox and Dysport

Adverse events after Botox injections received a lot of attention after the FDA mandated a "boxed warning" for both products. The patient Medication Guide lists a range of horrible things such as loss of bladder control or inability to speak; though these messages are required by the FDA, no serious adverse events related to spread of the product beyond the injection site have ever happened with cosmetic doses. This despite the millions of injections that have been done. One really has to wonder what the FDA's motives were in requiring the warning.

That said, it is wise to make sure that your injector is experienced and using the real thing. Bad things happened when some doctors bought some botulinum from a lab that normally supplies only research facilities.

Botox can be done in a safe way to avoid problems. First off, diluting the botox with less solution can go a long way. I typically use only 2cc of botox where some other physicians use up to 4 cc of saline. When you use more saline, you end up needing more volume for the same number of units. What this means is that the more volume you use the more the botox will be spread out. When the botox is spread out, it can affect other muscles around the area and cause unwanted effects.

In your specific question, having droopy eyelids can occure when the botox reaches the muscle that lifts up your eyelid. With a smaller volume with the same amount of botox, the botox is less likely to reach that muscle. Also to avoid reaching that muscle its important to stay away from the eye or the orbital part of the eye. As you inject botox as it approaches the middle part of the eyebrow you need to move the injections further away from the eye.

Knowing where to inject makes a big difference as well. For the forehead, you don't want to inject the botox too low. When you inject too low it can lead to your eyebrows descending as well. I usually try to stay at least superior to the halfway point in terms of the height of the forehead. Consulting a person specializing in the face is always an important thing to consider.

The main tip: use an experienced well-trained injector. Side effects happen, but they are extremely rare. Four specialties are qualified to administer facial cosmetic treatments: facial plastic surgery, dermatology, oculoplastic surgery, and plastic surgery. Choose one of these, but make sure they have years of experience including hundreds if not thousands of patient injections. 

Good luck and enjoy your Botox!