Side Effects
Does it hurt and what could go wrong?
Most patients find that Botox® injections cause little discomfort. Many compare the feeling to a little insect bite! As the treatment is very quick, the needles used are tiny and only minute amounts of liquid are being injected into the skin; few patients experience any significant pain.
A few patients do, however, prefer to have a cream called EMLA applied half an hour or so prior to treatment to help numb the skin.
Other risks or side effects include a small amount of temporary bleeding or mild swelling which may occur at the injection site. In some cases more extensive bruising may occur, especially around the eyes, but this can usually be covered up with make-up, and is only temporary.
Occasionally, patients experience a headache after treatment, and, very rarely, double vision.
When botulinum toxin is injected into the forehead area, there is a very slight possibility that it may cause weakness of the muscle holding up the eyelid causing a “partial ptosis” or drooping of the upper eyelid.
In experienced hands this tends to happen in less than 1% of patients and will disappear over a period of 2 – 10 weeks. Some doctors also use an eye drop called apraclonidine to help to speed up the recovery if this effect occurs.
If the forehead muscles are relaxed too much, especially in patients with looser skin, the treatment may cause the eyebrows to drop slightly. Again, this is only a temporary condition and will vanish usually within 10 weeks.
Sometimes, the eyebrow position may alter so that the edges of the eyebrows become elevated. Some women like this effect, but it is generally unwanted in men. It is easily corrected with a small amount of botulinum toxin injected above the raised area of the eyebrow to help change its position.
All patients should remember that because the results of botulinum toxin are not permanent, any unwanted effects will disappear usually within a 3 month period.
During 2003 there were some press reports claiming that Botox® may cause more wrinkles to appear. We have looked at these claims and can find no evidence in the scientific literature, at this point, to support these reports.
What should you do after treatment with Botulinum Toxin?
As we have said, your life can proceed as normal following an injection of botulinum toxin, but as with all medical procedures, it is wise to observe the advice of your practitioner as closely as possible to ensure that you get the full benefit of the treatment, free from complications.
Post-treatment advice may include:
for a few hours after injections actively contract and use the muscles in the treated area. Work your face and practise frowning and smiling! There is some evidence that this helps the treatment to work better by speeding up the absorption of botulinum toxin; for a few hours after injections do not rub, or massage the treated area, or undertake vigorous exercise. Avoid any form of facial treatment or massage to reduce the risk of the botulinum toxin spreading to adjacent muscles where it might cause the eyelid to droop; waiting for up to two weeks for the treatment to work fully, so be patient! Most people will find that, even after this period, if they try really hard, they can still move the muscles to a small extent in the area treated. This is quite normal. The aim of the treatment is not to prevent you from moving the muscles in your face, but merely to reduce the number of times that your muscles contract as this is when wrinkles occur.
Contact you practitioner after 14 days, if you find that you can still use the muscles treated to the same extent as before the treatment and you cannot see any apparent improvement, contact your practitioner and they will normally repeat the injections free of charge. Sometimes your practitioner will ask you to return two weeks after your first treatment so that they can monitor the results. This is good medical practice and nothing to be afraid of.
Contact your practitioner immediately if you experience any drooping of the eyelid or adverse eyebrow position or bruising problems, or infection following treatment.
Who should not have treatment with Botulinum Toxin
Botulinum toxin should not be used in women who are pregnant or breastfeeding. The manufacturers have not performed clinical studies in this group, for obvious reasons, although it is not thought to be dangerous to developing babies.
If you are currently trying for a baby, it might be wise to delay any cosmetic treatment.
Patients who have any diseases that affect muscle activity, may not be suitable for botulinum toxin injections. You must discuss this with your practitioner. Your practitioner may also ask you if you have a history of Bell’s palsy as this may affect the dosage that they use.
If you have any bleeding disorders or are taking drugs that affect bleeding time, or certain aminoglycoside antibiotics, your practitioner may advise against treatment.
You should be prepared to tell your practitioner about any medication which you are taking and any allergies you have.
