Can Botox Injected into the Forehead Go Through and Get into the Bloodstream?

Question

I have received botox injections quarterly for several years. Recently, I've not felt right--headachy (never happened before)and feel a little dazed, not as sharp as usual; could the recent injections have caused me harm?

Jerome Edelstein, MD · Answer

If the injection damages a vein then it can go into your bloodstream, but this is rare. Some patients do experience a mild headache and feel a little "out of it", but it only lasts a day or two.

Houtan Chaboki, MD · Answer

Venus2195 in Venus,

	As other Botox specialists have stated, Botox Cosmetic can theoretically enter the bloodstream after treatment injections. Botox is placed in the facial muscles to reduce wrinkles and considered safe by the FDA. However, one may occasionally have systemic reactions such as headache or flu-like symptoms, which are typically  temporary. Speak with your Botox provider regarding any concerns you may have. Best of luck.

	Dr. Chaboki

Ron Shelton, MD · Answer

When symptoms have been attributed, extremely rarely, to systemic effects, from possible circulatory absorption, the flu-like symptoms or headache these symptoms seemed to resolve after a couple or few days, not much longer. Again, this is very rare. It certainly is not an allergic reaction and you can have further treatments when this one wears off if you're comfortable with that option.

Scott Trimas, MD · Answer

It is very unlikely the botox gets into the general circulation. Even if it does, only a small amount can get there when injected from the forehead and it should not have any systemic effects. It is possible to get a headache from the injection and there have been some isolated reports of flu-like symptoms but those usually go away after several weeks. I would check back with your treating physician to express your concerns.

David Shafer, MD, FACS · Answer

What anything is possible, it is not probable.  Most likely the needle irritated a sensory nerve in your forehead which may give you temporary discomfort.  If your symptoms do not improve, you should see the advice of your doctor as it may just be coincidental and have nothing to do with the Botox at all.

	 

	Good Luck.

Kenneth D. Steinsapir, MD · Answer

Dear Venus

	The FDA recently required a much stronger warning regarding the use of BOTOX and other BoNT products.  Cosmetic BOTOX is very safe.  However, systemic side effects do occur.  Generally, for cosmetic treatments, they are short lived, like on the order of a week.  Headache and flu like symptoms are part of this syndrome.  It is not clear that the treatment has to actually be injected into a vessel for you to experience these symptoms.  Generally they are more bothersome than serious.  You will have to personally decide if the limited side effects are worrisome enough for you to continue receiving BOTOX treatment or to swear them off.  Personally, I find BOTOX so helpful that I am willing to put up with some minor short term side effects.

Richard Baxter, MD · Answer

In theory, Botox could be injected into a blood vessel but the dose is miniscule and wouldn't cause any harm. It is interesting that the patient information form required by the FDA has a list of serious systemic effects that might happen while also stating that none of them have occurred with cosmetic doses (despite tens of millions of patients having received BotoxCosmetic).

Michael A. Persky, MD · Answer

Hi Venus,

	It is possible that a very small dose of Botox can be directly injected into your vascular system.  The dose should be so small that it should not be able to cause the systemic effects that you are experiencing.  Best to consult with your injecting phsycian, and even with your internist to be sure that there is not some other problem causing your symptoms.  Good luck and be well.

	Dr. P