What Are the Common Side Effects of Botox?

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Botox Side Effects: Are They Common?

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What are the common side effects of Botox?

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Less than one percent of patients can experience a droopy eyebrow or eyelid for a few weeks to slight bruising. A physician without experience may inject too much in a given area, or inject in the wrong area. This may lead to a droopy brow or eyelid as mentioned, or a frozen and/or expressionless appearance. When looking to have treatment with Botox, it is best to seek the advice of a board certified dermatologist, plastic surgeon, or facial plastic surgeon. Doing your homework and choosing a physician who is an expert in performing Botox injections will help you obtain the best possible result. I hope this helps, and good luck to you. 

Beverly Hills Facial Plastic Surgeon
4.7 out of 5 stars 49 reviews

Common side effects of Botox

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Most common is BRUISING from the injection, especially crows feet. Experience does matter for the rest. If you have a relaxed brow, brow droop can occur. One in a thousand or so can get an eyelid droop, that goes away when the Botox does. Some patients need higher doses.

Side Effects And Adverse Events Associated With The Use Of BOTOX And BOTOX COSMETIC

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The common side effects for BOTOX treatment depend upon the indication for which BOTOX is being used. The adverse events associated with the treatment of frown lines is different than what is seen if BOTOX is used to treat some other medical conditions as: abnormal under arm sweating, spasmodic torticollis, involuntary tight closure of the eye lid, or abnormal alignment of the eyes (lazy eye).

In general, adverse events usually occur within the first week following injection of BOTOX; these are generally transient, but may have a duration of several months. Localized pain, tenderness, and/or bruising may be associated with the injection. Local weakness of the injected muscle(s) represents the expected pharmacological action of botulinum toxin. However, weakness of adjacent muscles may also occur due to spread of toxin. Additional adverse events include flu-like symptoms, nausea, headache, and eyelid droop.

It is these above reactions that are most likely to occur following the use of BOTOX Cosmetic for the treatment of frown lines or crow’s feet. If used as directed in the product insert, BOTOX Cosmetic is very safe for the treatment of frown lines and crow’s feet. The same safety profile is seen when using it “off label” (for non-approved indications) to treat other muscle groups in the face. To my knowledge, there has not been one serious adverse event that has been reported when BOTOX Cosmetic is used as directed for the treatment of frown lines or crow’s feet wrinkles.

Note: BOTOX and BOTOX Cosmetic are the same product, but packaged under different names depending upon the indication for use.

Below, I have included some additional information regarding the use of BOTOX for other medical conditions. Some of this information has been extracted from the product insert and medication guide that accompanies the BOTOX products. Some of these reported events may seem (somewhat) unrelated to the use of BOTOX for the specific treatment that was performed. But these where events that patients experienced during the FDA trials; and so they get reported whether they are directly related to the treatment of BOTOX or not.

PRIMARY AXILLARY HYPERHIDROSIS (excessive underarm sweating)
The most frequently reported adverse events (3 - 10% of patients) following injection of BOTOX includes injection site pain and bleeding, sweating that occurs in other body areas, infection, pharyngitis (sore throat), flu syndrome, headache, fever, neck or back pain, itching, and anxiety.

CERVICAL DYSTONIA (spasmodic torticollis)
The most frequently reported adverse reactions were difficulty swallowing (19%), upper respiratory infection (12%), neck pain (11%), and headache (11%). Other events (2-10% of patients) include: increased cough, flu syndrome, back pain, runny nose, dizziness, increased muscle tone (hypertonia), soreness at injection site, abnormal physical weakness/energy, oral dryness, speech disorder, fever, and nausea.

BLEPHAROSPASM (involuntary tight closure of the eye lid)
The most frequently reported treatment-related adverse reactions were eyelid droop (20.8%), superficial punctate keratitis (6.3%), and eye dryness (6.3%).

STRABISMUS (abnormal alignment of the eyes; lazy eye)
Extraocular muscles adjacent to the injection site can be affected, causing eyelid droop (15.7%) or vertical deviation of the eye (16.9%), especially with higher doses of BOTOX.

Other general safety information includes:

Serious and/or immediate hypersensitivity reactions have been reported. These reactions include anaphylaxis, urticaria (round itching red welts), soft tissue swelling, and shortness of breath.

Individuals with peripheral motor neuropathic diseases, amyotrophic lateral sclerosis, or neuromuscular junctional disorders (e.g., myasthenia gravis or Lambert-Eaton syndrome) should be monitored particularly closely when given botulinum toxin. Patients with neuromuscular disorders may be at increased risk of clinically significant effects including severe difficulty swallowing and respiratory compromise from typical doses of BOTOX.

Post-marketing safety data from BOTOX and other approved botulinum toxins suggest that botulinum toxin effects may, in some cases, be observed beyond the site of local injection. The symptoms are consistent with the mechanism of action of botulinum toxin and may include generalized muscle weakness, double vision, blurred vision, eyelid droop, difficulty swallowing, hoarseness or change or loss of voice, difficulty articulating speech, loss of bladder control, and breathing difficulties. These symptoms have been reported hours to weeks after injection. Swallowing and breathing difficulties can be life threatening and there have been reports of death related to spread of toxin effects. The risk of symptoms is probably greatest in children treated for spasticity but symptoms can also occur in adults treated for spasticity and other conditions, and particularly in those patients who have underlying conditions that would predispose them to these symptoms. In UNapproved uses, including spasticity in children and adults, and in approved indications, symptoms consistent with spread of toxin effect have been reported.

But I emphasize again - To my knowledge, there has NOT been one serious/life threatening adverse event that has been reported when BOTOX Cosmetic is used AS DIRECTED for the treatment of frown lines or crow’s feet wrinkles.

I have included this information, not to scare people, but to inform them. BOTOX, DYSPORT, and XEOMIN are very potent neurotoxins and should be administered by a trained physician or nurse. People who desire treatment with a botulinum neurotoxin type A should seek treatment with one of the FDA-approved products listed above. Do not receive treatment with black market products or toxins that have been purified by some other person or source.  Injector experience is important for the quality of the result ad the safety of the treatment. When administered properly, these for the treatment of facial lines and wrinkles these are products that have high patient satisfaction rates and great safety profiles.

This is why botulinum toxin type A (BOTOX Cosmetic and DYSPORT) treatments remain the most popular cosmetic procedure to date (since 2003!).

Kenneth Dembny, II, MD
Milwaukee Plastic Surgeon
4.9 out of 5 stars 36 reviews

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Common botox side effects

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In general, although relatively rare, side effects with Botox tend to be relatively minor and transient. Although not a direct side effect of the drug itself, bruising following injection can occur and avoiding aspirin and other non-steroidal anti-inflammatory drugs before the procedure can help. Skin reactions have been repoted but are not typically seen. When used around the eye, there can be a risk of eyelid or brow drooping/malposition and when used around the mouth, there is a risk of lip weakness. Ultimately, the other main "side effect" is that you are dissatisfied with the results. Fortunately, all of these side effects are rare and Botox is very safe and typically well tolerated. I would encourage you to discuss any concerns with your provider.

Sachin S. Pawar, MD
Milwaukee Facial Plastic Surgeon
5.0 out of 5 stars 35 reviews

Common side effects of Botox

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Bruising is always a risk with injections but should subside within 4-7 days, if it occurs at all. Avoiding blood thinners (some medications, multivitamins and even green tea) two weeks before and two weeks after a scheduled injection can help prevent or reduce the occurrence of bruising. Choosing an experienced injector is an important way to help prevent any negative side effects with Botox. Botox is not a permanent remedy and therefore any negative side effects are also not permanent.

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.