9 Botox (Botulinum Toxin) Side Effects You Should Know About

As the demand for less-invasive cosmetic procedures grows, more people are turning to treatments such as Botox Cosmetic (onabotulinumtoxinA) to enhance or change their appearance.

Botox is an injectable medication made from botulinum toxin - a neurotoxin that blocks signals between your nerves and muscles. This results in temporary paralysis of the muscle, which causes facial wrinkles to appear more smooth or relaxed.

Botox is available in two formulations, one for cosmetic use and another for medical use. Botox Cosmetic is typically injected by a trained professional at a med spa. The medical version of Botox is typically injected by a healthcare professional as a medical treatment for health conditions such as migraines, overactive bladder, and excessive sweating.

Botox is one of the most well-recognized brands in wrinkle-relaxing treatments, but is it safe?

Botox side effects at a glance

Botox is generally well tolerated. Most people recover quickly after each treatment. However, Botox side effects are still possible.

Side effects of Botox may include:

• Pain, swelling, or bruising near the injection site

• Headaches

• Droopy eyelids or eyebrows

• Dry and flaky skin

• Swallowing or breathing problems

• Dry eyes or eye damage

• Vision changes

• Muscle weakness

• Irregular heart rhythm

The side effects you experience depend on the amount of medication you receive and the areas of the body where you receive treatment. They may also hinge on your injector's technique and skill.

Here's what you need to know about nine notable Botox side effects.

1. Injection site reactions

Pain, bruising, and skin color changes around the injection site are the most common side effects of Botox. Injection site reactions tend to show up shortly after your treatment and should go away on their own.

To help prevent bruising after receiving Botox Cosmetic, try applying an ice pack to your skin soon after your injections. This decreases bleeding underneath the skin of the forehead and other parts of the face. You can also consider using an over-the-counter (OTC) topical pain medication, such as lidocaine cream.

A bacterial infection is a less common injection-related side effect, but it's still possible. When the needle penetrates the skin and goes into your muscle, it's possible for bacteria to get in. The best way to prevent this is to make sure the injection area is clean before each dose. The person administering your injections should take care of this as part of their routine prepwork.

2. Headaches

Headaches are another common Botox side effect. This may be because the medication can initially cause your muscles to spasm, but it isn't fully clear what causes it. The good news is that headaches aren't usually serious and clear up within a few days.

Staying hydrated and getting rest can help you get rid of a headache following your Botox injections. OTC pain medications, such as naproxen (Aleve) or ibuprofen (Advil, Motrin), can also help ease headaches if they're too bothersome. But it's a good idea to ask your healthcare professional before taking any new medications or supplements to make sure they're safe for you to use.

3. Forehead side effects

Using Botox on the forehead can lead to some specific side effects.

A droopy eyelid - called blepharoptosis - is one common side effect. It's reported to affect up to 20% of people who receive Botox treatments on the forehead. A droopy eyebrow, known as brow ptosis, is also possible. Both of these effects are usually seen on only one eye, and should return to normal within 3 to 6 weeks. However, it may take up to 3 months.

The "Mephisto sign" is another forehead side effect of Botox Cosmetic. It can cause the end of your eyebrow to be slightly higher than the eyebrow itself. This can make you appear surprised or skeptical. This side effect is also temporary, but it may last for up to 3 months.

Forehead Botox treatments can also exaggerate wrinkles. This happens when a strong border is created between a paralyzed muscle and a non-paralyzed muscle in the forehead. Again, this effect is temporary.

4. Dry skin

Some people experience dry and flaky skin around the areas of their Botox injections. Although the cause isn't completely clear, this appears to happen because Botox lowers your body's ability to produce sweat. This can make the skin feel drier, flakier, and tighter.

You can help ease dry skin by applying moisturizer to your skin regularly. Try to avoid moisturizers with fragrances or dyes as they may contain chemicals that further irritate dry skin.

5. Spreading of Botox toxin

Although rare, Botox can spread beyond the areas where it's injected and cause serious problems. This risk goes up if Botox is injected into areas of your body that aren't recommended. Botox Cosmetic is only FDA approved for use on your face. On the other hand, Botox for medical use can be administered in other areas of the body.

Developing botulism, an uncommon but serious health condition, is also possible. Depending on where Botox travels in your body, the toxin can spread and cause symptoms such as muscle weakness or breathing troubles. These effects can vary in severity and appear hours to weeks after the injections are administered.

6. Difficulty swallowing or breathing

Botox can weaken the muscles that control swallowing and breathing in the mouth, throat, and neck. This is especially dangerous for people who already have problems with swallowing or breathing.

Although these symptoms are uncommon, they can appear hours to weeks after a Botox session. If you notice difficulty swallowing or breathing after receiving Botox, call 911 or go to the nearest ER as soon as you can.

7. Eye and vision problems

Botox can affect the muscles that control your eyelids. So you might blink less after your injections. This can result in problems such as dry eye, eye irritation, or eye damage. Chronic dry eye can lead to a scratched cornea.

If dry or irritated eyes start to bother you, consider placing OTC lubricating eye drops into the affected eye. You can also use an eye patch to prevent dirt and allergens from further irritating your eyes.

Botox can also affect the muscles that control eye movements and cause you to experience problems such as double vision or difficulty judging distance. If this problem pops up, reach out to an eye specialist (ophthalmologist).

8. Heart problems

Botox can rarely affect your heart. It has the potential to cause heart rhythm problems (arrhythmia) or even heart attacks. This can be more likely if you already have heart problems. Be sure to talk about any heart problems with your healthcare professional before receiving Botox.

9. Nerve or muscle problems

Because Botox injections can cause muscle weakness, people who already have nerve or muscle-related problems - such as myasthenia gravis - should be careful. Botox could make your condition worse.

When should you contact your healthcare professional about side effects from Botox?

Side effects of Botox typically appear within the first week after getting the injections. They should go away with time. But make sure to let your healthcare professional know if these side effects are bothersome, get worse, or don't go away.

However, if you start to have trouble swallowing, talking, or breathing after getting Botox injections, get emergency medical help right away. These problems can put you at risk for choking and serious breathing problems. They might also be symptoms of botulism, so it's important to get treatment quickly.

Frequently asked questions