Can you be poisoned by too much Botox? (photo)

Question

Many people who have warned against putting "rat poison" in the face, which gives you pause. Is it possible to get poisoned by too much Botox like the National Enquirer is claiming here?

Michael A. Zadeh, MD, FACS · Answer

Botox is a toxin, but it is not rat poison. Like any medication, if given too much then there can be adverse effects that occur. The amount of Botox needed to cause an overdose or "poisoning" is so high that it has never happened when Botox has been used for medical purposes. When done by an experienced injector the results of Botox will look very natural and you will still be able to maintain normal facial expressions.

Martin Jugenburg, MD · Answer

Rat poison is an anti-coagulation medication called warfarin or coumadin and is used for patients who had blood clots form.  Botox is a completely different medication.  Botox used for cosmetic purposes is very minimal and will not have any serious side effects.  1000s of units are required to cause serious harm while a cosmetic botox injection will have less than a 100 units

James M. Ridgway, MD, FACS · Answer

This is a fun question and it make good headlines as well :)  As with many things, going to excess can have significant health implications. With enough water one can drown, but on a hot summer day a tall glass is what is needed. Botox has cosmetic and medical indications. From my perspective it is an excellent medication that has many  siginificant clinical benefits. Lethal doses for Botox is on the level of 40 units/kg (Biglan AW, Patel BC, May M, et al: Botulinum A toxin. In May M, Schaitkin BM, editors: The Facial Nerve, ed 2, New York, 2001, Thieme Medical Publishers, p 441.) and would never be achieved in a standard clinical setting. Although this statement made the headline, other ones such as "Hillary Clinton Adopts Alien Baby" have also been made the headline in the National Enquirer.Be healthy and be well,James M. Ridgway, MD, FACS

Harold J. Kaplan, MD · Answer

Hello.  The catchy headline sure does grab the attention of readers, but the information is not accurate.  Botulinum Toxin Type A for cosmetic purposes has a better safety record than generic Aspirin.  This is because such tiny amounts of the drug are used to obtain the desired results.There has never been a case of poisoning by Botox Cosmetic and it's highly unlikely that there ever will be one.  Like we tell our patients, alcohol is poison too and if you drink enough you can die.  It's all about the doses and using the product or drug properly.For examples of before and after pictures of Botox patients in Torrance and Orange, CA, click the link below.

Samir Undavia, MD · Answer

It is true that Botox is technically 'Botulinum Toxin', but it is a medication, just like any other. It blocks nerve communication with the muscle  only where it is injected, in a very similar way to cholesterol medication blocking cholesterol from being formed.  In fact, the amount of Botox needed to create toxicity in the body is over 100 fully filled 1 cc syringes.  Your facial plastic surgeon will only have one in his or her hand at the time of your injection.  Most importantly, the FDA has approved both Botox and Dysport for this use.

Choon Kia Yeo, MD · Answer

Yes, you can be poisoned by too much Botox!Like all medications, Botox has to be administered within the therapeutic range. Too little is not effective, and too much is an overdose. With extreme dosages (well beyond the approved amounts), the treatment could be lethal, and that's why, technically, it could be used as a rat poison. Botox blocks the transmission of the neurotransmitter acetyl choline from the nerves. As you know, it blocks muscle contractions and even sweat gland production, depending on where it is administered. Botox for the face is FDA-approved for frown lines and eye lines. It is very safe and has many other medical applications. Hope this answer your question and concern.Aloha, Dr. C. K. Yeo

Stephen Weber MD, FACS · Answer

I am not aware of any cases of poisoning by cosmetic Botox. As Dr. Ellis pointed out there is a large safety margin between the typical cosmetic dose (25 - 75 units) in my practice and the level at which botulism type symptoms can occur. Most issues with Botox are either related to the procedure (bruise) or to injection into or diffusion of the product into the wrong muscle. The only botulism type complications I'm aware of resulted from research grade products ordered off of the internet and used by someone not properly trained resulting in a massive overdose. Trust your face to a professional injector - either a Plastic Surgeon or Dermatologist. I hope this information is helpful for you.Stephen Weber MD, FACSDenver Facial Plastic Surgeon

David A. F. Ellis, MD · Answer

The normal dose for Cosmetic Botox is under 100 units. It is estimated that 3200 units would be required to kill a human. Patients who need Botox  who have had strokes etc often require 500 units. Be the way, Warfarin is what is used in rat poison not Botox. Sensational headlines like this sell newspapers and can lead to mis-interpretation.

David Mathes, MD · Answer

Botox is safe when used in the small doses as is done in
clinical practice. The major side-effect of using too much Botox in the face is
temporary dysfunction of a specific muscle. However, this is very rare and when
Botox is used by someone with the proper training. There have been reports of
people trying to make illegal Botox and this is where the where serious
problems have occurred.

Peter J. Jenkin, MD, FAAD · Answer

One can certainly have too much botox injected or have it injected incorrectly which can lead to some side effects such as a droopy eyelid or lowering of the eyebrows.  However, all the side effects disappear when the botox wears off in 3 months so no long term effects will be seen.  The bulk of the National Enquirer article was talking about the distortion caused by an illegal silicone filler which was injected and there was also speculation that there was an illegal "Botox" injected.  You'll remember a few years ago at least one person died because they were injected with a fake homemade "Botox" product.  The lesson-avoid "discount botox" which could be a cheap unproven knock-off and have your injections done by board certified dermatologists and you'll be fine in the long run.  Hope this is helpful.

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