Can botox injections permanently injure facial nerve?

I came across an article that was written back in 2010 regarding the actress "Dana Delany" and how she allegedly had a facial nerve that was struck while injecting botox which caused a "permanent droop". I've never heard of this before and assumed all Botox effects are temporary ?

Doctor Answers 11

Botox doesn't cause permanent facial nerve injury

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The duration of Botox is 3-4 months for the most part. The way Botox works is in the nerve endings in the muscle are inhibited from releasing acetycholine. That means the muscle can't contract. "Hitting the facial nerve" would not have any effect on the the nerve. Injections are done in muscles because that's where the effect is from Botox.

Panama City Facial Plastic Surgeon
4.9 out of 5 stars 75 reviews

Injections permanently injuring a nerve

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Hello Nickj,

The nerve that controls the facial muscles starts just below your ear and fans out across your face going from deep to superficial.  The closer to the middle of the face you get the more the nerve branches and reconnects meaning multiple nerves help to stimulate the muscles.  The nerve itself is about 3 millimeters wide at its largest and then gets progressively smaller towards the middle of the face.  As a surgeon there are particular surgeries that I have done that required me to trace these nerves out along their length so this provides an excellent understanding of the facial nerve

Having described all of that, the needles used for injections are very thin.  So even if the nerve was accidentally hit, the chance of any permanent damage is essentially unheard of.  The only place it would be at risk is an area that is not injected for cosmetics (around the parotid gland for sweating with eating) and only then if the needle was placed way too deeply.  Without reading that article I cannot comment specifically on it but you are correct, the effects of Botox are temporary.  They tend to last about 3 months.  Prior to any injection, you should discuss the risks with your physician.

I hope this helps and good luck. 

William Marshall Guy, MD
The Woodlands Facial Plastic Surgeon
5.0 out of 5 stars 31 reviews

Botox and facial nerve injury

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Hi Nickj, it would be exceedingly unlikely that Botox injection would cause any type of facial nerve injury let alone permanent injury.

Todd C. Miller, MD
Newport Beach Facial Plastic Surgeon

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Botox and Nerve Injury

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Botox cannot permanently damage nerves even if injected into them.  I suggest seeing a cosmetic dermatologist or plastic surgeon with experience.  Best, Dr. Emer.

Jason Emer, MD
Los Angeles Dermatologic Surgeon
4.8 out of 5 stars 207 reviews

Botox and facial nerve injury

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Botox would be extremely unlikely to cause permanent damage to a facial nerve. He needle is so tiny, and the results are temporary. The only way I can think this might happen is if a large needle was used and the needle caused the damage. But very doubtful and unlikely.

Anthony Youn, MD, FACS
Detroit Plastic Surgeon

Botox and nerves

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Hello.  This article is most likely untrue.  The needle used to inject Botox is very small.  In contrast, we inject some fillers with a much larger needle and "droop" is not seen as a complication.  Certainly, I've never seen permanent droop as a complication in clinical practice.  Hope that helped!

J. Matthew Knight, MD
Orlando Dermatologic Surgeon

Botox is temporary

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Botox is a temporary medication that does not permanently affect nerves.

The needle used to inject botox is very fine, so permanently damaging a major facial nerve is highly unlikely.

Unless the article was published in a medical journal, I would take it with a grain of salt.

Ramona Behshad, MD
Saint Louis Dermatologic Surgeon

Permanent Injury

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Botox is not likely to cause a permanent droop. BUT, if the needle were to cut the nerve, it can do exactly that (if injected in a vulnerable spot). If this were to happen, don't blame the Botox, blame the injector, who obviously would not be well-trained in the technique.          jlr

John Louis Ratz, MD
Lagrange Dermatologist

Can botox injections permanently injure facial nerve?

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Thanks for your question.  I feel this is unlikely.  Botox is typically injected directly into the muscle and has an effect on the portion of the nerves closest to the muscle.  It doesn't affect the entire nerve, and the effect it has wears off completely in 3-5 months.  The type of nerve injury you are describing would require cutting the nerve with the Botox needle, which is not likely to happen given the small caliber of the needles most injectors typically use.  To avoid problems and complications with Botox the best thing a patient can do is select a well trained and qualified physician injector for their treatments.  Best of luck to you!

Alix J. Charles, MD
Hinsdale Dermatologic Surgeon

Can botox injections permanently injure facial nerve

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One can come up with many theories as to why Botox was blamed, like claiming to have an injectable, which has an essential zero chance of nerve injury, to a small surgical procedure, which can have nerve injuries. Having said that, unless the needle actually cuts the nerve, I see no way that a permanent nerve injury is possible. That would be almost impossible as the needle size used for Botox is so small that cutting through the entire nerve would likely never happen.

Julio Garcia, MD
Las Vegas Plastic Surgeon
4.8 out of 5 stars 27 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.