Complications of Cosmetic Botox Therapy
In a poll, 77% of patients treated with Botox for cosmetic reasons felt more comfortable with their body. Greater than 80% thought the treatment was beneficial, and 100% would recommend it for others. Botox should not be given to people allergic to any part of the Botox preparation. It should not be given to people with unrealistic expectations or who are unsure about it. It should be avoided in patients with some nerve and muscle disorders, who are pregnant, or have skin inflammation over the injection site. Because there is a human protein in the mixture, there is a possible risk of viral disease transmission, although never reported. Some medicines interact with Botox and should be avoided including aminoglycoside antibiotics, cholinesterase inhibitors, succinyscholine, magnesium sulfate, quinidine, calcium channel blockers, lincoamides, and polymixins.
Complications include injection site pain, swelling, redness, and bruising. Allergic reactions from rashes to shock can occur. There was one death reported for someone treated for neck and back pain. Nausea and upper respiratory infections occur but the connection to Botox is unclear. Other side effects include swallowing problems, dry eye, and eyelid droop. There are rare reports of heart attacks and abnormal heart rhythms with noncosmetic use but a direct relationship is not proven. Botulism like in food poisoning is extremely rare. There are other reports of dry mouth, vision changes, and decreased sweating.
Patient Interview
Patients can go through a questionnaire beforehand to give them more time to think about the issues. People with psychiatric conditions must be handled carefully. There is a syndrome called botulinophilia, describing patients who continually seek Botox treatments. There patients should not be treated.
Physical Exam
The patient should be checked for skin infection, rashes, facial asymmetry, scarring, and previous signs of surgery. Patients with thick sagging skin with deep folds that do not improve much when the skin is stretched are not good Botox candidates. Patients with previous eyelid surgery are at higher risk of excessive lower lid sagging. Snap tests on the lower lid should be done to test the tone of the lid. People with already drooping eyebrows or lids are not good for injections to treat forehead wrinkles and risking further sagging. Nonreversible side effects have never been reported. In tests 43.7% of Botox treated patients complained of side effects compared to 41.5% who got a placebo (a fake drug). The most common complaints are headache, cold symptoms, lid drooping, nausea, and pain. Using more concentrated drug injected in lower volumes causes less Botox spread and fewer side effects. This is why patients are also told to remain upright for 4 hours and not rub the area. There is a case report of someone getting Botox into the forehead leading to immediate muscle paralysis. To avoid bleeding patients should avoid taking blood thinners like aspirin and nonsteroidal anti-inflammatory agents for a week. Other products also may thin the blood like vitamin E, ginseng, ginko, garlic, and ginger and should be avoided for 2 weeks.
Forehead
When forehead wrinkles are treated, there is a risk of the brow drooping. Therefore Botox injections must be dept above the mid brow. Muscles that depress the brow can also be injected to raise the brow. Some providers routinely inject the frontalis (forehead) muscle and brow depressor muscles to treat forehead wrinkles and avoid brow sagging at the same time. However, here you risk leaving one with inability to move the eyebrow at all. Eyelid drooping can happen if Botox leaks into the upper eyelid. Apraclonidine (Iopidine) or phenylephrine (Neosynephrine, 2.5%) can reverse the problem. If the outside portion of the forehead muscle is not given enough Botox, it may pull the outside end of the eyebrow up, giving a Jack Nicholson look. Drooping of the eye lid occurs 2-14 days after injection and lasts for 2-4 weeks.
Eyelid drooping Hematoma (bleeding) around the eye
In a poll, 77% of patients treated with Botox for cosmetic reasons felt more comfortable with their body. Greater than 80% thought the treatment was beneficial, and 100% would recommend it for others. Botox should not be given to people allergic to any part of the Botox preparation. It should not be given to people with unrealistic expectations or who are unsure about it. It should be avoided in patients with some nerve and muscle disorders, who are pregnant, or have skin inflammation over the injection site. Because there is a human protein in the mixture, there is a possible risk of viral disease transmission, although never reported. Some medicines interact with Botox and should be avoided including aminoglycoside antibiotics, cholinesterase inhibitors, succinyscholine, magnesium sulfate, quinidine, calcium channel blockers, lincoamides, and polymixins.
Complications include injection site pain, swelling, redness, and bruising. Allergic reactions from rashes to shock can occur. There was one death reported for someone treated for neck and back pain. Nausea and upper respiratory infections occur but the connection to Botox is unclear. Other side effects include swallowing problems, dry eye, and eyelid droop. There are rare reports of heart attacks and abnormal heart rhythms with noncosmetic use but a direct relationship is not proven. Botulism like in food poisoning is extremely rare. There are other reports of dry mouth, vision changes, and decreased sweating.
Patient Interview
Patients can go through a questionnaire beforehand to give them more time to think about the issues. People with psychiatric conditions must be handled carefully. There is a syndrome called botulinophilia, describing patients who continually seek Botox treatments. There patients should not be treated.
Physical Exam
The patient should be checked for skin infection, rashes, facial asymmetry, scarring, and previous signs of surgery. Patients with thick sagging skin with deep folds that do not improve much when the skin is stretched are not good Botox candidates. Patients with previous eyelid surgery are at higher risk of excessive lower lid sagging. Snap tests on the lower lid should be done to test the tone of the lid. People with already drooping eyebrows or lids are not good for injections to treat forehead wrinkles and risking further sagging. Nonreversible side effects have never been reported. In tests 43.7% of Botox treated patients complained of side effects compared to 41.5% who got a placebo (a fake drug). The most common complaints are headache, cold symptoms, lid drooping, nausea, and pain. Using more concentrated drug injected in lower volumes causes less Botox spread and fewer side effects. This is why patients are also told to remain upright for 4 hours and not rub the area. There is a case report of someone getting Botox into the forehead leading to immediate muscle paralysis. To avoid bleeding patients should avoid taking blood thinners like aspirin and nonsteroidal anti-inflammatory agents for a week. Other products also may thin the blood like vitamin E, ginseng, ginko, garlic, and ginger and should be avoided for 2 weeks.
Forehead
When forehead wrinkles are treated, there is a risk of the brow drooping. Therefore Botox injections must be dept above the mid brow. Muscles that depress the brow can also be injected to raise the brow. Some providers routinely inject the frontalis (forehead) muscle and brow depressor muscles to treat forehead wrinkles and avoid brow sagging at the same time. However, here you risk leaving one with inability to move the eyebrow at all. Eyelid drooping can happen if Botox leaks into the upper eyelid. Apraclonidine (Iopidine) or phenylephrine (Neosynephrine, 2.5%) can reverse the problem. If the outside portion of the forehead muscle is not given enough Botox, it may pull the outside end of the eyebrow up, giving a Jack Nicholson look. Drooping of the eye lid occurs 2-14 days after injection and lasts for 2-4 weeks.
Eyelid drooping Hematoma (bleeding) around the eye
Periocular
When Crow’s feet are treated, bruising can occur. Therefore injections are kept superficial. Using ice helps. Other complications include double vision, inability to close the eye, and upper lip sagging. Eye problems can be avoided by keeping injections 1 cm outside the lateral corner of the eye. If the eye won’t close, it should be taped shut at night and eye drops used until the Botox wears off. Injections below the eye can cause dry eye. When the muscle under the eye is weakened by treatment, the lower eyelid may droop, and too much of the white of the eye will show. Patients at risk for this happening have sagging skin under the eye, already show too much white of the eye pretreatment, or have had lower eyelid surgery.
Lip and Midface
Treatment of smile lines can cause one or both corners of the lip to droop. Other complications include drooling, an asymmetric smile, and problems eating and speaking. Treatment of the neck may be complicated by swallowing problems, hoarseness, and neck weakness.
Lip assymmetry
When Crow’s feet are treated, bruising can occur. Therefore injections are kept superficial. Using ice helps. Other complications include double vision, inability to close the eye, and upper lip sagging. Eye problems can be avoided by keeping injections 1 cm outside the lateral corner of the eye. If the eye won’t close, it should be taped shut at night and eye drops used until the Botox wears off. Injections below the eye can cause dry eye. When the muscle under the eye is weakened by treatment, the lower eyelid may droop, and too much of the white of the eye will show. Patients at risk for this happening have sagging skin under the eye, already show too much white of the eye pretreatment, or have had lower eyelid surgery.
Lip and Midface
Treatment of smile lines can cause one or both corners of the lip to droop. Other complications include drooling, an asymmetric smile, and problems eating and speaking. Treatment of the neck may be complicated by swallowing problems, hoarseness, and neck weakness.
Lip assymmetry
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