Why Do So Few Dermatologists and Plastic Surgeons Admit Potential Eventual Pitfalls of Readily Injecting Botox?

Every action causes a reaction. I have experienced and witnessed "reactions" associated with Botox weakening muscles (no matter how expertly injected) causing eventual and lingering problems. Whether injected "correctly" in the forehead region, crowsfeet, or worst of all -- under the eyes, other muscles respond in kind. Botox may be great at the start, but ptosis, fat protrusions, assymetries, etc. can & do happen, leaving "customers" no fix other than costly procedures. Is it all about profit?

Doctor Answers 9

Botox,Dysport,etc:Medical Literature that lies

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Recently a patient came to see me after being treated with Botox®. She could only open one eye and could barely smile. She looked more like she had a stroke than an aesthetic treatment. I called the physician who treated this woman, and found that he had used a unusually large volume of diluted Botox®. When I told him his dilution was far too large he says he had read dilution of Botox® did not matter. I told him this article was incorrect and the large volume of fluid he used caused the toxin to reach unintended muscles.

This type of incorrect information has turned present day medical literature into something akin to a mystery novel. Every time I pick up a medical journal. I wonder if what I read is accurate or just a sales pitch from pharmaceutical companies, aka Big Pharma.I often wonder why there are not legions of Physicians at my side, standing up to Big Pharma. This is same feeling I had when the American Foundation for Aids Research was founded at my home in 1984. Why can't the others see the sky is really falling? The medical literature must be scientifically accurate and not just promote drug use by Big Pharma. For example, the literature on Dysport gives similar injection points to Botox and Dysport is a smaller molecule and diffuses more. Where is that information readily available?

Beverly Hills Dermatologic Surgeon

Complications of Botox

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The potential complications of Botox or any cosmetic treatment should always be discussed before a treatment is performed. That said, in experienced and highly trained hands (e.g. dermatologist or plastic surgeon), the side effects you describe are thankfully quite rare and usually easily corrected.

Benjamin Barankin, MD, FRCPC
Toronto Dermatologic Surgeon

Informing patients is not easy....

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Things that seem obvious to us, are not always so clear to patients....

Extensive information about treatments, possible side effects and alternatives should be done BEFORE a treatment is done. If not done properly disappointment is imminent.

Experience will determine whether wrinkles are the result of activity or because of continuous tension on the muscle. Besides that, volume loss, gravity and loss of elasticity have an influence as well. Explaining those influences and the fact that they can change in time gives the patients the chance to get realistic expectations which in my opinion is the most important determinator of satisfaction after a procedure..

Unfortunately not all doctors are good teachers...., they intend well but do not always succeed, and unfortunately not all patients are good students...... they need to do there part of investigating as well.

Hope this clarifies.




Ivar van Heijningen, MD
Belgium Plastic Surgeon

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Problems associated with Botox

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I am a big believer in informed consent and explain all the potential risks and benefits of a treatment. Perhaps the reason I do not m  ention those that you refer to is because I have never seen them in practice.  The risk of complications will be lower with a board certiifed plastic surgeon or dermatologist who is experienced and knowledgeable about facial musculature rather than someone without that training.

Are there frequent problems with Botox treatments?

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When used properly the complications that you describe are very rare. I sense that you've had a bad experience with Botox which is very unfortunate. Ptosis, fat protrusion and asymmetry which you've mentioned are not common. Further, asymmetry can be readily treated with careful touch-ups of the Botox treatment. To answer your question, nearly every plastic surgeon and dermatologist uses Botox because it just works and it creates happy patients. If you've had a bad experience, I'd recommend seeking out a more experienced injector. I hope this information is helpful.

Stephen Weber MD, FACS

Botox problems

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Yes weakening does occur, sometimes in areas we don't want but none of the problems are permanent. I have not seen permanent ptosis, fat protrusion, asymmetries attributable to Botox. Aging does occur no matter what we do, Botox freezes muscle temporarily, it does not stop the clock. Blaming Botox for the aging process is not fair to the product.

Peter T. Truong, MD
Fresno Oculoplastic Surgeon
4.9 out of 5 stars 43 reviews

Botox works

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I am always saddened to hear these questions as I think Botox is a 'slam-dunk' response to most aging foreheads.  I think the biggest change since I started using Botox over 15 years ago is the concept of using less rather than more.  I would prefer to see a relaxed face rather than a frozen one.  Ask you injector to think about this concept.  Good luck!

Steven Swengel, MD
Los Gatos Dermatologic Surgeon
5.0 out of 5 stars 13 reviews

Botox is the best treatment for crows feet and the glabellar lines

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There are risks with all aesthetic treatments. As more off-label uses are discovered, the side effects may increase. Crows feet and the "11" creases between the eyebrows bother many patients and they are extremely happy when these lines are softened and Botox is the number one treatment for this area and the glabellar frown lines. Laser resurfacing tends not to help these lines related to underlying muscle contraction as the skin may look smoother for a few weeks but as the resurfaced skin continues to crease when the muscles are active, the creases will recur. As additional areas of the face are injected, certain muscles might be affected creating undesired results.

Patients should see board-certified dermatologists and plastic surgeons for their Botox and discuss the risks with them in the consultation.

The information provided in Dr. Shelton's answer is for educational purposes only and is not intended to constitute medical advice.  The information provided should not be relied upon as a substitute for consultations with a qualified health professional who may be familiar with your individual medical needs.

Ronald Shelton, MD
Manhattan Dermatologic Surgeon
4.9 out of 5 stars 39 reviews

Botox failurers

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Your question is disturbing.  I just have not seen nor even heard about these unwanted problems.  Yours is a fairly unique event.  I would question who your injectors have been. 

The subtle responses of associated zones can be eased by experienced treatment placement and patient selection. 

H. Michael Roark, MD
San Diego Plastic Surgeon
5.0 out of 5 stars 16 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.