More than 20 years after being approved by the FDA to minimize wrinkles, BOTOX has compiled a sterling safety profile. With millions of procedures performed annually, it’s the most popular cosmetic treatment in the world. While its effectiveness is well-documented, we believe it’s important that our patients understand the possible side effects and complications associated with BOTOX.
Common Short-Term Side Effects
When it comes to FDA-approved drugs, a brand has to disclose, on the packaging, every single side effect reported by its product’s users. Neurotoxins, such as BOTOX, Dysport®, and DAXXIFY®, come with a laundry list of potential side effects—but all drugs do. The vast majority of BOTOX side effects are mild and temporary, often resolving within a few days to weeks after treatment. The frequency and severity of these side effects can vary from person to person.
These include:
Injection Site Reactions
The most common side effects are related to the injection process itself. These may include:
- Redness
- Swelling
- Bruising
- Tenderness or pain at the injection site
These reactions typically subside within 24 to 48 hours. Applying ice to the affected area can help alleviate these symptoms.
Headache
Some patients report experiencing headaches after BOTOX injections, particularly when treating the forehead area. These headaches are usually mild and resolve within 24 to 48 hours.
Temporary Facial Weakness
Slight weakness in the muscles treated is an expected outcome of BOTOX treatment. However, sometimes this weakness can extend to nearby muscles, causing:
- Slightly droopy eyelids (ptosis)
- Asymmetry in facial expressions
- Difficulty making certain facial movements
These effects are typically mild and resolve as the BOTOX wears off, usually within a few weeks.
Dry Eyes or Excessive Tearing
When BOTOX is injected near the eyes, such as when treating crow’s feet, it can occasionally affect tear production, leading to either dry eyes or excessive tearing. These symptoms generally improve within a few weeks.
Flu-Like Symptoms
Shortly after treatment, you might experience mild flu-like symptoms, including fatigue, muscle aches, or a low-grade fever. As with the other symptoms, these will likely only last a day or two.
Rare Complications
Even though serious complications following BOTOX treatments are uncommon, they can occur. It is important to be aware of these potential risks, even if they affect only a small percentage of patients.
Spreading to Unwanted Areas
BOTOX works by limiting the movement of specific muscles that cause wrinkles. That’s why it’s important for injectors to be precise during the treatments. In rare cases, the effects can spread beyond the treatment area. Symptoms may include:
- Muscle weakness in areas distant from the injection site
- Difficulty swallowing (dysphagia)
- Speech problems
- Breathing difficulties
These symptoms can occur hours to weeks after treatment and require immediate medical attention.
Allergic Reactions
While extremely rare, some individuals may experience an allergic reaction to BOTOX. Symptoms can range from mild (itching, rash) to severe (anaphylaxis). Severe allergic reactions are medical emergencies and require immediate treatment.
Vision Problems
Other rare complications that can occur when injections are performed near the eyes include double vision, blurred vision, or decreased eyesight. These issues are typically temporary, but you should contact your doctor immediately.
Cardiovascular Events
There have been rare reports of arrhythmia and myocardial infarction following BOTOX injections, although a cause-and-effect relationship hasn’t been established. If you have pre-existing cardiovascular conditions, you should discuss these risks with the injector before getting BOTOX.
Infection
As with any injection procedure, there’s a small risk of infection at the injection site. Proper sterilization techniques and aftercare instructions significantly reduce this risk.
Are There Long-Term Side Effects of BOTOX?
One of the most commonly asked questions is, what happens if you keep getting BOTOX injections? If you like the way the injections make you look, you’ll have to go back for more injections every 4 or 5 months to maintain the effect (read more about how long BOTOX lasts). Research on the long-term effects of neurotoxins is limited, but there are no studies that indicate a negative effect of getting repeated BOTOX injections.
However, there is evidence of several positive long-term side effects of regular BOTOX injections:
- Delayed Aging Process—BOTOX injections may help delay the appearance of aging, especially when started early. Those in their 20s or 30s can potentially benefit from early BOTOX treatments by preventing the formation of wrinkles.
- Longer-Lasting Results Over Time – With repeated use, BOTOX injections may start to last longer than the initial 3-4 month period. As muscles get used to the effects and weaken over time, future injections may provide more prolonged results.
- Slowing Development of New Wrinkles – With repeat injections over time, BOTOX may help slow the development of new wrinkles in treated areas.
The Importance of Choosing Skilled Injectors
Choosing an experienced provider for BOTOX injections is the best way to minimize the risks of side effects or complications. Heavy-handed injectors who use too much BOTOX, especially on the forehead, can lead to unwanted results. Too much BOTOX on the forehead leads to muscle atrophy, which can then result in sagging eyebrows.
At Dallas Center for Dermatology & Aesthetics, we are transparent about the side effects and risks of all treatments. We encourage patients to discuss any concerns or questions they may have before, during, or after their BOTOX treatment. You can request a consultation with one of our board-certified dermatologists using the online form or by calling us at (214) 631-7546.
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