Why do vitamin E and fish oil interefere with the effects of Botulinum Toxin?

Question

I had an injection of botulinum toxin on my forehead and glabella and it started wearing off only after 5 months. A doctor has told me that vitamine E and fish oil may interfere with the effects of botox, and at the moment of the treatment I had been taking omega 3 and vitamine E pills for a month. Could it be the reason for lasting such a short time ?

David Gilpin, MD · Answer

Thank you for your question.  Botox typically lasts anywhere from 3-4 months, and I think that is wonderful that your treatments are lasting 5 months!  Botox is a purified protein which works by relaxing the muscles of the face.  Once these are relaxed the overlying fine lines and wrinkles are softened and diminished.  Vitamin D and Fish oil tend to thin the blood and possibly could give you a higher risk of the bruising after your Botox injections.  However, I have not read anywhere that these agents interfere with the action of Botox.Be sure to consult with a board certified injector for your Botox treatments.  Here you will have a full evaluation and be able to discuss your goals.I hope that this helps!–David Gilpin

Julia Ann Sullivan Miller, MD · Answer

Vitamin E and fish oil do not directly interact with Botox.  Since both of these substances cause a thinning of the blood, it is recommended to refrain from using them prior to Botox injections to decrease the chance of bruising.

Bridget Fitzgibbons, NMD · Answer

the average on label duration of botulinum toxin is 3-6 months. Doctors commonly will ask if a patient is taking fish oils, vitamin E, blood thinners of any sort due to their effect on blood; they are natural blood thinners therefore may cause bleeding which may cause bruising. Although not a contradiction it is nice to know if you are susceptible to bleeding or bruising so proper steps can be put in place to reduce chances of a bruise.

Chad Robbins, MD · Answer

Thank you for your question.  The fact that you got 5 months of botox before wearing off is great!  Most people need their next treatment after 3-4 months max, so you are very lucky.  Vitamin E and fish oil cause your blood to thin which can cause you to bruise from the injections, but otherwise does not affect your results.

Sean Doherty, MD, FACS · Answer

The reason that patients are told not to take Vitamin E and Fish Oil prior to Botox is because both thin the blood which can lead to more bruising. Taking either doesn't affect Botox's efficacy. In fact, if your results lasted 5 months, that is a long time. Most patients need to have another treatment at the 3-4 month mark. Count yourself lucky. Hope this helps.

Azin Meshkinpour, MD, MPH, FAAD · Answer

Botox will still relax your muscles even if you take blood thinners.  You may bruise more if you are taking supplements such as the vitamin E and fish oil that you mentioned.  You noticed your botox to be wearing off after 5 months which is actually a very long duration for its effects.  Typically botox lasts 3-4 months. I have noticed that patients who regularly maintain their botox over years, tend to require less in terms of units.

Alex Eshaghian, MD, PhD · Answer

Thank you for your question pepita84. 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 in the office where I can view the skin in multiple angles and observe
wrinkles formed with facial expression. However, I hope the information
provided here is useful.The appearance of frown lines is variable from
person to person. Usually they are in a vertical orientation but sometimes they
can be oblique and sometimes a horizontal line is seen across the upper portion
of the nasal bridge. The most common variation is to have two parallel lines,
hence the common term "11's" to describe them. But some people have
one, three, or more lines. Some people also will see a bulge in the area when
contracting the muscle. This bulge is smoothened out after a Botox treatment.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. Taking such blood thinners may increase the risk of bruising with a treatment. 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.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 as described above. 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!

Shaun Patel, MD · Answer

On average, the results of Botox/Dysport last for 3-4 months. Supplements such as Vitamin E and fish oil can increase the risk of bruising after injections but otherwise do not alter the effects of Botox/Dysport.

Melvin Elson, MD · Answer

The only effect that these might have is a very slight increase in the possibility of bruising but no effect at all on the Botox

Martie Gidon, MD, FRCPC, FAAD · Answer

The average length of time for Botox to last in the glabellar area is 4 months and usually less for the forehead.  You are fortunate that your Botox effect lasted 5 months.  Vitamin E and fish oil can result in some bruising right at the time of injection but should not make Botox wear off more quickly.

Why do vitamin E and fish oil interefere with the effects of Botulinum Toxin?

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