I get 10 units, every 3 months, for 2 years. I still have severe anxiety about Botox reactions. Can you help me with facts?

Question

I do take a Xanax .25 to help with my fears. The needle does not scare me at all and there is no pain for me at all. I just worry about the actual Botox safety. I just automatically think I am going to be on a ventilator for 2 months. An irrational thought but could you please attempt to help me. I just need some positive thoughts to replace negative ones please. Also I have never had a rash or anything negative. Just negative thoughts about dying from this.

Nelson Castillo, MD · Answer

Thank you for sharing your question and I am sorry to hear of your anxiety.  Botox has been used for decades with little risk to patient safety.  That said your own two year history without issues should offer you the best reassurance.

Anteneh Roba, MD · Answer

Based on the description of your symptoms,  no matter how much any doctor on this thread may try to alleviate your anxiety I don’t think it will change anything. You already know Botox for cosmetic application won’t cause respiratory failure. What you need is a psychologist to help you with the anxiety you have.

Alex Eshaghian, MD, PhD · Answer

Thank you for your question jchevalier76. I understand your concern. Botox is a purified protein used to address wrinkles associated with facial expression. When injected into the skin Botox will relax the muscles and smoothen out the overlying wrinkles. The most common areas of treatment are in the upper face. These include the horizontal lines seen on the upper forehead when one raises the brows, the vertical lines seen between the brows when one frowns (frown lines), and the crow's feet seen around the eyes when one smiles.

It is difficult to make an assessment without a formal exam where the entire medical history is reviewed. However, I hope the information provided here is useful.Botox was originally obtained from the bacterium Clostridium botulinum, the bacteria that causes botulism. These bacteria can be found in certain foods that are not properly preserved. When it is ingested the bacteria multiplies and spreads through the bloodstream releasing a protein called botulinum toxin, the active ingredient in Botox. As the bacteria multiply more and more of the toxin is released. The botulinum toxin attaches to the nerves on large muscles such as those responsible for breathing or those in the limbs. This makes it difficult to breath and perform activities such as walking. The live bacteria are required to multiply and continue releasing large amounts of the toxin. In the absence of the bacteria, as when Botox is used for cosmetic purposes, more toxin is not produced. Also, the amount of toxin used for cosmetic treatments is miniscule compared to the amount required to produce effects such as difficulty breathing. Finally, the minute amount of Botox used in cosmetic treatments is not enough to pass into the bloodstream and spread to other muscles, as evidenced by the lack of systemic side effects.
The safety record of Botox is well established. The product has been used for over 20 years for a variety of treatments with minimal side effects. Botox is amongst the safest treatments for treating facial wrinkles.
While Botox is one of the safest treatments offered, there are some situations where it is not appropriate. These include anyone who has an allergy to any of the inactive ingredients or who has had an allergic reaction to any botulinum product including Botox, Dysport, Xeomin, or Myobloc. The safety and efficacy of Botox has not been established in women who are pregnant, trying to become pregnant, or breast feeding. Therefore, women in these categories are advised to wait until breast feeding is completed prior to having a Botox treatment. Botox should not be placed in the skin on the site of an infection. Those who are taking an aminoglycoside antibiotic, an anesthetic, D-penicillamine, antimalarials, or immunosuppressants should not be treated, nor should those who have undergone chemotherapy within the previous six months. It is important to avoid blood thinners before and after a treatment. These include both prescription and non-prescription medications such as warfarin (coumadin), aspirin, ibuprofen, alcohol, fish oil, vitamin E, and ginko biloba. Those with conditions that affect muscles and nerves such as amyotrophic lateral sclerosis (ALS or Lou Gehrig's disease), myasthenia gravis, or Lambert-Eaton syndrome should not undergo Botox treatments.
If I had a patient with the concern described here I would say that the issue is anxiety and I would refer the patient to a general physician, psychiatrist, or psychologist for help.
With any injection, there are risks such as pain, bleeding, bruising, redness, swelling, tenderness, and infection. We take special precautions to minimize these risks such as using a painless technique. We also treat bruises with a laser as early as the next day. Bruises usually resolve within two weeks if untreated. After a laser treatment bruises usually resolve in 1-3 days, but may still take two weeks for full resolution. In addition to these risks, with Botox there is also a risk that the product spreads or diffuses to nearby structures. Spread to nearby muscles can lead to side effects such as the temporary appearance of droopy eyelids or a temporary asymmetric smile.
  
After a Botox treatment, I recommend that my patients avoid heat exposure, alcohol consumption, and strenuous exercise for 24 hours and not lie down flat for four hours. This is because all of these activities may possibly lead to the movement of the product and consequent side effects such as droopy eyelids. Although there have been no definitive studies shown that these actually occur and some physicians do not provide such aftercare instructions, in the absence of data I err on the side of caution and recommend that my patients avoid such activities.
  
Please consult with a doctor for specific recommendations. Good luck!

Leonard Grossman, MD · Answer

I've been using BOTOX for more than 25 years and it is one of the safest products on the market today. All the problems generally come from the poor administration of Botox and extremely rare reactions of patients to the preservative rather than the botox itself. Knowledge of the anatomy of the face and body is extremely important during the administration of Botox. Make sure you go to a qualified plastic surgeon for your Botox Administration. Good luck from New York City

Shelin Tkatch, MD, FRCSC · Answer

You have been having low dose treatment for a long time without problems. You already know your fear of ending up on a ventilator is not rational. The best way to work through irrational fear/anxiety is with the help of a clinical counsellor skilled in cognitive behaviour therapy. Ask your primary care provider for a referral to a counsellor. Best, Dr. Tkatch

I get 10 units, every 3 months, for 2 years. I still have severe anxiety about Botox reactions. Can you help me with facts?

Answers (6)

Answer: Botox safety

Answer: Botox safety

Answer: How to cope with severe anxiety about Botox safety?

Answer: How to cope with severe anxiety about Botox safety?

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Everything you need to know about Botox

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I get 10 units, every 3 months, for 2 years. I still have severe anxiety about Botox reactions. Can you help me with facts?

Answers (6)

Answer: Botox safety

Answer: Botox safety

Answer: How to cope with severe anxiety about Botox safety?

Answer: How to cope with severe anxiety about Botox safety?

Browse related questions

Recommended reading

Everything you need to know about Botox

Our mission is to create a world where every investment in modern beauty is Worth It.