The most common side effect of BOTOX treatment is temporary bruising. Another
side effect is headaches; however this is a rare occurrence. If headaches do
occur, they are usually gone within 24 to 48 hours.
BOTOX should not be given with patients who have certain neuromuscular disorders
such as ALS, myasthenia gravis, or Lambert-Eaton syndrome – as they might be at
an increased risk of serious side effects.
Occasionally there are cases of incomplete muscle paralysis of the injected
muscles, leading to an irregular contour upon frowning or raising ones eyebrows
– which could mimic swelling. This is either due to inadequate dosing of the
BOTOX, or incomplete area of the muscle injected. Swelling in general with
injections of BOTOX is unusual; however you might get slight swelling at the
injection sites for a few hours.
Patients may develop a small
hematoma (bruise) at or near the injection site.
Hematoma is the result of the needle injuring a small blood vessel and will also
resolve within 1-2 weeks. In order for a hematoma not to happen, physicians will
tell their patients to be off of all anti-inflammatory medications and aspirin
products two weeks prior to any injections to minimize the risk of bruising.
Patients are also advised not to
work out or do excessive physical exercise immediately following your
The anatomy of the tear trough area can make the
or a bruise appear worse. The skin of that area can be very thin and show uneven
injections or hematomas more easily and for a longer period.
If after several weeks the bruising does not go
away, sometimes IPL - Intense Pulse Laser which is an non-invasive laser
treatment, is recommended. This IPL Laser helps capillaries and bruising
by breaking up the old blood that might be left behind in the tissue of the
You should have BOTOX and fillers injected by cosmetically trained specialists
(plastic surgeon, facial plastic surgeon, dermatologist, and oculoplastic
surgeon); as they have a very good understanding of the anatomy of the
antagonistic muscle pairs in the face.
Too much BOTOX or even a little in the wrong place can cause your eyebrows to
droop. If the BOTOX is placed too low on the forehead or injected into the wrong
muscle group, the muscle that raises the forehead (frontalis) will be
inactivated and not able to lift the brow. A droopy brow can look like a droopy
If you do get a droopy eye from BOTOX, some physicians are using Alphagan and
Iopidine to correct the situation. It is considered safe and the only
contraindication is use of a (MAO) monoamine oxidase inhibitor. Alphagan works
by stimulating a second set of muscles called Muller's muscle which causes
lifting of the eyelid muscle.
Lopidine (Apraclonidine) Eye Drops mode of action is that it goes to work on a
tiny muscle in your eyelid and help pull it up 1 to 3 mm. The drops must be
repeated a few times a day for a continued effect. If you have drooping eyebrows
leading to full eyelids, these eye drops will have no effect.
Illustration from the textbook Baumann
L. "Cosmetic Dermatology: Principles and Practice"
McGraw Hill, Philadelphia, March 2002.
Injections in this "Danger
Zone" can cause a droopy eyelid
Corporation, the maker of Restylane and Perlane, has marketed a new Botulinum toxin A product called
Dysport. This product has
just received FDA
approval. Dysport will now compete
directly with BOTOX in the United States market.
Mentor Corporation is
investigating another Botulinum toxin A product under the name
is not known when this product will reach the market.
There is also a Botulinum
toxin B product available in the United States under the name
NeuroBloc. This product is distributed by
Neurosciences and is primarily used for medical conditions and not
In France, Allergan markets
BOTOX Cosmetic under the name Vistabel.