Complications of Botox, Dysport, and other botulinum products

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Let’s talk about the potential complications of Botox, Dysport, and other botulinum products.

First, most patients are concerned with the fact that these are toxins. That is a fact. These are toxins. It’s a toxin produced by the bacteria Clostridium Botulinum. It works by temporarily paralyzing muscle activity by stopping nerve signals to that particular muscle. It sounds scary, but here’s a couple of things to keep in mind.

  1. It only acts where it’s injected, and doesn’t go to the rest of the body in a clinically significant way.
  2. The amounts used to get rid of wrinkles on the forehead, glabella and the crow’s feet aren’t nearly enough toxin to result in any life threatening effects.

In order to produce a lethal effect for a hundred pound person, five thousand equivalent units of botulinum toxin would need to be used. That’s over fifty thousand dollars worth of Botox. One syringe worth of botulinum toxin typically has under fifty units. It’s impossible to cause a life threatening event with the amounts that we typically use, but still there are complications that can occur if care is not taken.

Common Side Effects or Complications

The first and most common side effect or complication that patients get is a short term headache. That’s pretty common, and it lasts for a few days.

Bruising can also happen, especially if patients are on aspirin, ibuprofen or other blood thinners. Typically that bruise will go from being purple to pink to green to yellow, and then it’ll finally disappear within seven to ten days. Arnica cream can help sometimes to speed up that recovery. Green tinted makeup can also be used to help cover that up. Now rarely a particular botulinum product might not work, indicating that there might be an allergy to that brand. In those instances, we typically switch brands and that can be helpful. I have yet to meet a patient that has an antibody to all the different types of the botulinum products, but I suppose it could still happen.

Another rare complication is that there can be asymmetry in the final results where one site might have a little less movement or the brow might be higher on a particular side. Usually a small touch up at two weeks is enough to even out those asymmetries.

One of the more dreaded complications is ptosis or a droopy eyelid where botulinum toxin was injected too close to the upper eyelid muscles. In those cases, the eyelid can be droopy for up to three to four months, but for most patients it lasts about six weeks or so. With a safe medicated eye drop that helps to lift the eyelid, the droopiness is really less noticeable. Now dropping a brow can also occur if the toxin is injected too close to the eyebrow. There’s no good medical remedy aside from waiting three months or so for this, but most physicians will not inject within a two centimeter region around the eyebrow as you get closer to the temples, so that helps prevent that complication.

I hope this helps you understand some of the potential complications of using Botox and Dysport. They’re all pretty rare and for the most part treatable. It’s important that they’re temporary, and that you understand that.

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