Written by Aleksandra Agranovich
The Dangers of Botox Injections
Botulinum toxin (Botox) has been used for decades to treat varying cosmetic conditions and headaches. Botox is a neurotoxin that is produced by a bacterium called Clostridium botulinum and prevents the release of the neurotransmitter acetylcholine (Ach), thereby inducing muscle stiffness and causing paralysis. Many dermatologists inject their patients with Botox to temporarily relax facial muscles that cause wrinkles. This procedure involves the use of a refrigerated Botox vile, a syringe, and takes approximately a couple of minutes to complete. The effects of Botox injections usually last three to four months before waring off. Although a simple Botox procedure is very quick, it may cost up to fifteen dollars per unit of Botox, which may easily add up…
Most people usually rave about how amazing and flawless Botox looks, but what are the hidden dangers of this product and is it truly safe? There are typically no contraindications for Botox except hypersensitivity or severe allergic reaction. According to the article that has been referenced below, Botox should not be injected into infected skin, wounds, areas with psoriasis or eczema. It is also very important to avoid Botox injections if a woman is pregnant or breastfeeding. The botulinum toxin may potentially cause fetal harm if injected in large amounts.
Another factor that may interact with Botox may include certain drugs like cyclosporin, acetylcholinesterase inhibitors, and specific antibiotics. Cyclosporin, for example, can potentiate the effects of Botox and cause a paralyzing effect (Althawadi,2022). Some of the rare but serious side effects of Botox may include keloid scaring at the injection site, drooping of the skin, respiratory problems, facial weakness, headache, and pain
Botox for Headaches and Migraines
Throughout the years, botulinum toxin has been studied for the treatment of headaches and migraines. Evidence suggests that Botox can be used as a pain management technique in patients who suffer from constant tension-type headaches and neuropathic pain disorders. According to a study conducted by Carruthers MD, patients who were injected with Botox showed a "decrease in the incidence and severity of headaches for a period of three to four months, along with a reduction in the use of short-term analgesics" (Carruthers, 2004). Within this study, Botox was proven to be a safe and effective measure for the treatment of such conditions.
Refrences
Althawadi N, Ujam A, Visavadia B. Botox hidden dangers. Br Dent J. 2022;232(4):192-193. doi:10.1038/s41415-022-4006-3
Carruthers J, Carruthers A. Botox: beyond wrinkles. Clin Dermatol. 2004;22(1):89-93. doi:10.1016/j.clindermatol.2003.11.013
Khawaja HA, Hernandez-Perez E. Botox in dermatology. Int J Dermatol. 2001;40(5):311-317. doi:10.1046/j.1365-4362.2001.01176.x
Since the FDA first approved BOTOX (onabotulinumtoxinA) in 1989 for the treatment of two rare eye muscle disorders—blepharospasm and strabismus in adults—its therapeutic applications have expanded significantly. OnabotulinumtoxinA is now FDA-approved for 12 therapeutic indications, including chronic migraine, overactive bladder, urinary incontinence due to a neurologic condition in adults, cervical dystonia, adult and pediatric spasticity, severe underarm sweating (axillary hyperhidrosis), and pediatric detrusor overactivity associated with a neurologic condition.
On April 15, 2002, the FDA approved BOTOX® for cosmetic use as a temporary treatment for moderate to severe frown lines in adults. To distinguish it from its therapeutic uses, it was marketed as BOTOX® Cosmetic. This prescription medicine is FDA-approved for three specific areas: moderate to severe forehead lines, lateral canthal lines, and glabellar lines. It was the first treatment of its kind and remains the only FDA-approved product for improving the appearance of moderate to severe frown lines, crow’s feet, and forehead lines in adults.
The clinical effects of botulinum toxin typically begin to appear within one to three days, peak in one to four weeks, and gradually diminish after three to four months. However, the duration of the response varies based on the injection site, dose, and specific formulation used. Some patients, especially those who have had repeated injections in the same area, may experience benefits for six months or longer, potentially due to muscle atrophy.
When patients are carefully selected, and proper dosing and injection techniques are utilized, the use of botulinum toxin for cosmetic purposes is generally safe. Side effects are usually mild and temporary, including swelling or bruising at the injection site, mild headaches, or flu-like symptoms. Occasionally, unintended muscle impairment may occur, often due to poor injection technique or inappropriate patient selection. Thus, a conservative approach to dosing is advisable to minimize adverse effects.
A review of available data underscores the impressive safety record of botulinum toxin. A 2004 systematic review and meta-analysis of randomized trials involving 1,425 patients reported no serious adverse effects from onabotulinumtoxinA used for medical or cosmetic purposes. Between 1989 and 2003, only 36 serious adverse effects associated with cosmetic use were reported to the FDA. These included injection site reactions, headaches, focal facial paralysis, muscle weakness, flu-like symptoms, dysphagia, respiratory compromise, cardiac arrhythmia, seizures, ocular abnormalities, and allergic reactions. Notably, 13 of these cases involved patients with underlying medical conditions that may have contributed to the adverse event.
Despite the low risk of serious adverse effects with cosmetic use, there have been reports of severe side effects such as aspiration, dysphagia, pneumonia, anaphylaxis, botulism, and death. Consequently, in 2009, the FDA mandated boxed warnings on botulinum toxin product labels and required a Risk Evaluation and Mitigation Strategy for all such products.
Due to the temporary nature of botulinum toxin’s effects, patients need ongoing treatments to maintain their results. The safety of repeated treatments was assessed in a retrospective study involving over 4,000 treatments in 945 patients for upper face lines, with each patient receiving at least three consecutive treatment cycles. Only mild to moderate adverse effects, such as bruising and ptosis, were observed, with a decrease in side effects noted over repeated injections. Similar findings have been reported in studies of botulinum toxin type A for medical uses, and repeat injections with abobotulinumtoxinA have also shown good tolerance in large open-label studies.
Overall, while BOTOX has a well-established safety profile, ongoing monitoring and careful patient selection remain crucial to minimize the risk of adverse effects and ensure the best therapeutic and cosmetic outcomes.
BOTOX® Cosmetic (Boe-tox) (onabotulinumtoxinA) for Injection. (2021, February). U.S. Food and Drug Administration. Retrieved from https://www.rxabbvie.com/pdf/botox_medguide.pdf
BOTOX® Cosmetic (Boe-tox) (onabotulinumtoxinA) for Injection. (2021, February). U.S. Food and Drug Administration. Retrieved from https://www.rxabbvie.com/pdf/botox_medguide.pdf