James D. McMahan, M.D., F.A.C.S.
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What are the risks of Botox® injections?

As with any injectable treatment, bruising is a risk with Botox® injections.  Bruising is actually relatively rare in the brow area which is the most common area for Botox® treatments.  They are a little more common in the forehead area and probably most common when performing Botox® injections around the eyes to treat crow’s feet.

Patients can reduce their risk for bruising if they remember to avoid taking any medication which can thin their blood for about two weeks before their Botox® treatment.  The most obvious is aspirin, but other common medications which can increase the risk of bleeding and bruising includes Vitamin E, fish oil, Advil®, ibuprofen and many other anti-inflammatory drugs.

Another risk of Botox® injections is spread of the toxin into unintended areas.  The best known side effect of this nature is a droopy eyelid as a result of the product getting into the muscle that raises the eyelid.  The effect is an eyelid that sits 2-3 millimeters lower than the other.  Fortunately, this is a relatively rare complication of Botox® injections and it lasts only for about two to three weeks.  In addition, there is an eye drop which can correct much of the lid sagging and can be purchased over the counter at most pharmacies.  To prevent this problem from occurring, physicians try to keep their injections about one centimeter above the brow and advise their patients not to rub the injected area or to perform strenuous activities for at least two hours after their treatment.

Pain with the injections is another obvious risk and can be reduced with ice and the use of very small needles.  Occasional patients will have a mild headache after injections, however, relief of both the frequency and severity of migraine and stress headaches are often noted and are the reason that some patients get Botox® treatments.

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