Risks of Botox® Injections

Since Botox® is injected with a fine needle, it is possible to injure small blood vessels during the injection process and therefore bleeding and bruising is a risk.  It is relatively rare to see bruising in the brow area which is the most common area for Botox® injections; probably because the tissue in that area is quite thick so that a deep bruise may not be visible on the surface of the skin.  Bruising is more common on the forehead because the area is thinner and more injections are given in that area which increases the risk.  The crow’s feet near the eyes and lower eyelids have the thinnest skin and are where bruises are seen most commonly.

Avoid Blood Thinners

To reduce the risk of bleeding, it is helpful to avoid taking any medication that can thin the blood such as aspirin, vitamin E, ibuprofen, fish oil, etc. for at least a week before treatment; two weeks is even better.

Incomplete Correction

Incomplete correction of wrinkles is always possible and can be corrected with another injection but it is best to wait at least one week to make sure that it is not just a delayed response.  Some patients prefer to keep a little motion in the muscles treated so that they still have some facial expression and less of a mask-like appearance.  In certain patients who have low positioned brow muscles, it is best to leave some of the lower muscle untreated.  This is because injection in that area carries a higher risk of a droopy eyelid (ptosis) from the neurotoxin getting into the muscle that elevated the eyelid.

Eyelid Ptosis

If Botox® leaks down from the brow into the eyelid it can cause drooping of the lid.  This is one of the most feared complications of Botox® injections but fortunately occurs in about one out of every two or three hundred treatments.  It generally only lasts for two to three weeks and can be improved with over the counter eye drops containing naphazoline hydrochloride.  To avoid this problem, patients should avoid rubbing the area that was injected and they should not perform strenuous activity for at least two hours after their treatment.

When the transverse lines in the forehead are treated with Botox®, the muscle which elevates the brows is weakened which can cause the brows to sag.  Patients with low brows to begin with should either avoid Botox® in their foreheads or at least have a more conservative treatment.

Sagging Eyebrows

Injection of Botox® into the forehead muscles to reduce or eliminate transverse forehead lines is not yet approved by the FDA; it is OK to inject that area, it is just considered an ‘off-label’ use of the product.  One of the consequences of treating this area is possible lowering of the brows because the muscle that is being weakened is the one that elevates the brows.  Those who have low brows to begin with may want to think twice about treating these lines or, at least, consider leaving the lower brow muscles intact to avoid significant brow depression.

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