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What can go wrong with Botox?

What can go wrong with Botox?

The risks of Botox are minimal but include:

1/ Bruising from the injection.

2/The lateral brow peaking. This is comparatively common and is an overactive frontalis muscle pulling the lateral eyebrow too high. The cure is to place a tiny amount of Botox at the apex of the peak.

3/ A lower resting eyebrow position. This can occur when the forehead is treated to eliminate horizontal forehead lines. As the frontalis muscle is no longer pulling the eyebrows upwards, they slip down into their resting position. There is a risk that this resting position is considered too low, making the upper eyelid more hooded. This risk increases with age. This risk can be minimized by reducing the Botox dose delivered to the forehead and making sure the muscles that pull the eyebrows down are fully treated. If this eyebrow drop occurs there is unfortunately no quick fix. The Botox to the forehead will wear off and the frontalis will start to pull the eyebrows upwards again in a few weeks. The key is to use less Botox to the forehead in the future, but there is therefore an inevitable tradeoff between a smooth forehead with lower eyebrow, and a higher eyebrow but with more horizontal forehead lines.

4. Mickey mouse smile. This occurs when the Botox at the crow’s feet area prevents the orbicularis muscle tightening when you smile. The deeper smile muscle that lifts the corner of your mouth then lifts your cheek against a smoother lateral eye area, generating a single deeper "mickey mouse" crease. There is no quick fix for this. The appearance will improve as the Botox wears off and the key is to use less Botox to the lower parts of the crow’s feet in the future.


Botox vs Disport

The market leaders for botulinum toxins have been Allergan with Botox, and Ipsen with Dysport. Ipsen Announces FDA Approval of Dysport® (abobotulinumtoxinA) for the treatment of Upper Limb Spasticity in Children, Excluding Cerebral Palsy. Botox has been so dominant that the use of botulinum toxin has become known as Botox treatment.

 Galderma has now brought a smaller vial of the same botulinum toxin as Dysport to the market with the trade name of Azzalure, previously marketed under the brand name Dysport but licensed only to treat medical conditions such as cerebral palsy, facial tics, and strokes - but it can now be used for cosmetic use. Both drugs contain protein called botulinum toxin, which is produced by the bacterium Clostridium botulinum. Dysport and all botulinum toxin products have a Boxed Warning, which states that the effects of the botulinum toxin may spread from the area of injection to other areas of the body, causing symptoms similar to those of botulism.1 Those symptoms include swallowing and breathing difficulties that can be life-threatening.1 Dysport is contraindicated in patients with known hypersensitivity to any botulinum toxin preparation or to any of the components; or in the presence of infection at the proposed injection site(s); or in patients known to be allergic to cow’s milk protein.1 The potency Units of Dysport are specific to the preparation and assay method utilized.1 They are not interchangeable with other preparations of botulinum toxin products 

The manufacturers obviously want to persuade us that their product is the better product. The reality is that Botox, Dysport and Azzalure are all equally good. There is a subtle difference in that at the same volume of injection Dysport and Azzalure spread a little further. This is useful when treating the forehead but less useful closer to the eye. The solution when using these preparations is to use higher dose in smaller volume around the eye. In summary, I wouldn't worry which botulinum your practitioner uses so long as they are familiar with its characteristics.  It is worth knowing which product you are being given, and at what dose, such that if you move to a different practitioner, they know what your preferences are.

1. Avoid Rubbing Your Face for 24-48 hours After Botox Injections. ...

2. Limit Sun Exposure and Photo Damage.

The FDA approved 20 units of Botox for frown lines, 24 units for crow’s feet, and 20 units for forehead lines


Botox vs Disport

The market leaders for botulinum toxins have been Allergan with Botox, and Ipsen with Dysport. Ipsen Announces FDA Approval of Dysport® (abobotulinumtoxinA) for the treatment of Upper Limb Spasticity in Children, Excluding Cerebral Palsy. Botox has been so dominant that the use of botulinum toxin has become known as Botox treatment.

 Galderma has now brought a smaller vial of the same botulinum toxin as Dysport to the market with the trade name of Azzalure, previously marketed under the brand name Dysport but licensed only to treat medical conditions such as cerebral palsy, facial tics, and strokes - but it can now be used for cosmetic use. Both drugs contain protein called botulinum toxin, which is produced by the bacterium Clostridium botulinum. Dysport and all botulinum toxin products have a Boxed Warning, which states that the effects of the botulinum toxin may spread from the area of injection to other areas of the body, causing symptoms similar to those of botulism.1 Those symptoms include swallowing and breathing difficulties that can be life-threatening.1 Dysport is contraindicated in patients with known hypersensitivity to any botulinum toxin preparation or to any of the components; or in the presence of infection at the proposed injection site(s); or in patients known to be allergic to cow’s milk protein.1 The potency Units of Dysport are specific to the preparation and assay method utilized.1 They are not interchangeable with other preparations of botulinum toxin products 

The manufacturers obviously want to persuade us that their product is the better product. The reality is that Botox, Dysport and Azzalure are all equally good. There is a subtle difference in that at the same volume of injection Dysport and Azzalure spread a little further. This is useful when treating the forehead but less useful closer to the eye. The solution when using these preparations is to use higher dose in smaller volume around the eye. In summary, I wouldn't worry which botulinum your practitioner uses so long as they are familiar with its characteristics.  It is worth knowing which product you are being given, and at what dose, such that if you move to a different practitioner, they know what your preferences are.

1. Avoid Rubbing Your Face for 24-48 hours After Botox Injections. ...

2. Limit Sun Exposure and Photo Damage.

The FDA approved 20 units of Botox for frown lines, 24 units for crow’s feet, and 20 units for forehead lines


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