Top 6 BOTOX Side effects you need to know right now

Back to my favorite injectable drug... BOTOX and it's not so long a list of side effects.

BOTOX is increasingly safe and has been around for decades, with first documented use for cosmetic purposes in 1989.

With any injectable procedure you should think about possible side effects.

#1 - Bruising

Relatively common (after all, you need a needle to get the injection completed). In my experience, the location of the injection plays an important role. Injections around the eye tend to have a higher chance of bruising, although the bruise can occur anywhere a needle is used. So how do you decrease the chances of a bruise?

• no alcohol 5 days prior to the procedure
• no NSAIDS (Ibuprofen, Advil, Aleve) 5 days prior to procedure - Tylenol is ok
• no retin-a type creams or vitamin E creams 3 days prior to procedure
• Use ice during the procedure
• Arnica cream before and after the procedure
• most importantly try not to have the injections right before an important event. Bruises can be bad sometimes!

#2 - Asymmetry | Uneven Results

Typically BOTOX is used to treat the forehead. The forehead controls our eyebrow height and architecture. When these muscles are relaxed with injections the results can sometimes be seen in the eyebrows. The undesired effect of asymmetry is not common, but does occur. Most faces have resting asymmetry (sorry I just knocked your self esteem down a notch). BOTOX when improperly placed (or even when properly placed) can result in exaggeration or new asymmetry. This is easily fixed with a second time 1 or 2 spots of injection of a few 'extra units' to even out the undesired effect.

#3 - Under treatment | Over treatment

Under treatment - not getting the desired effect of BOTOX can occur and is easily fixed with additional units. Some patients do require more units in order to get the look they want or any effect at all. You can work with your injector to better understand how many units you need.

Over treatment - Too much BOTOX can cause the "frozen appearance" or ptosis (see #5). It is always easier to add more BOTOX, you cannot take it away!

#4 - Spock Brow | Jack Nicholson Brow

When treating the forehead, injectors are extra careful to prevent eyelid drooping (which can happen, see #5). To do this injectors tend to concentrate on the central forehead (more commonly in women). This can sometimes lead to eyebrow arching, some patients request this look, others do not like it. The BOTOX works by relaxing the forehead muscle and if the outer part of your forehead is still very strong it can pick up the eyebrow into an arched shape sometimes. Thankfully this is usually easily corrected with a couple extra units of properly placed injections.  

 #5 - Eyelid drooping | Brow Drooping | Double vision

Thankfully rather rare, but does occur. The more aggressive your treatment is and your injector is, the higher the likelihood of ptosis or eyelid drooping. This is not a fun side-effect but can happen. This is the result of the forehead usually being too heavily treated on the outside. There are special eye drops your injector can likely provide that can help increase your recovery rate to about 2 weeks.

#6 - Headache and flu like symptoms

 A very common side effect is Headache. They are usually short in duration and a results of the BOTOX itself or the needle from the injection. The good news is, BOTOX will usually help you get less headaches over the course of its 3-4 months of action. Tylenol and or a muscle relaxer can help with this short term headache. Flu symptoms are uncommon but do occur and last for up to 3 days.

Do not fret, side effects are usually short lived. Your injector can help facilitate any adverse effects you have and give you an estimated timeline.

More to come..

Dr. B

P.S. Don't jump to conclusions, injections usually take 3-7 days to start working!

Melted Money: The impact on emergent and urgent healthcare of the ice bucket challenge.

The ice bucket challenge has swept the nation and has brought a lot of attention to one of many diseases that truly needed the attention, Amyotrophic lateral sclerosis. ALS and many other progressive spinal cord & neurologic diseases have in no doubt benefited from the selfless donations of numerous Americans over the last few months in thanks to the ice bucket challenge.

If you are unaware, in short. The ice bucket challenge is a viral marketing sensation, mostly on Facebook, of "nominees" usually while pledging a donation dumping a bucket of ice water on their heads and nominating three additional pledgers. I must admit, sounds like a nice summer treat.

From sources close to the ALS foundation I have heard upwards of 22 million dollars in donations to this point, which is fantastic. My growing concern is for the ice bucket challenge "fails". As with any viral phenomenon, nominees want to one-up one another over and over and over again. This has resulted in more "unique" ways to preform the simple task of dumping a bucket of ice water on ones head.

As you may have found out (Google 'ice bucket challenge fail'). People dumping absurdly large buckets of ice from heights that are unsafe and in conditions that are unsafe onto peoples heads. This has resulted in multiple injuries including fractures, lacerations, concussions, eye damage, cardiogenic shock, multiple contusions, and a plethora of other injuries.

The lesser of these injuries in an emergency room likely costs between $600 - $1000, while the more serious can result in surgery, hospital admission, and short-to-long term disability (although I have not seen or heard of any to this point) could run in the five to six digit range.

The economic impact on the healthcare system will likely be minute from these injuries. The challenge has done a wonderful thing pulling awareness for this cause. The point of my article is to bring awareness to the general public on safety.

We have all acted purely on impulse before, all done things we know we should not have. Just try to think before you act during the ice bucket challenge and donate as much as you can to help improve outcomes for ALS.

Happy Icing

How many units do I really need?! BOTOX

This post is for BOTOX newbies and BOTOX veterans.
BOTOX is a very complicated medication to grasp the concept of. I usually explain concept multiple times per day. My goal in this article is to give you a little insight into BOTOX and the dosing.
 

First off:

BOTOX is a trademarked name by Allergan. Kind of like, er..um.. Kleenex.

Good with your analogies?

BOTOX is to botulinum toxin as Kleenex is to tissue paper. Got it?

 

 

Ok lets move on....

 

There are two other alternatives that are FDA approved at the current time of writing (2014): Dysport and Xeomin. They can be used interchangeably with BOTOX and usually have very similar results. Dysport is a completely different dosage and pricing will vary accordingly in most offices.

 

 
 

Females | Typical Areas of Injection

11 lines (Glabellar complex): 20 units on average to start

Horizontal lines of the forehead (furrows): 10 units on average to start

Crows Feet (lateral canthal lines): 10 units per eye on average

 

Males | Typical Areas of Injection

11 lines (Glabellar complex): 20 - 40 units on average depending on muscle bulk

Horizontal lines of forehead (furrows): 10 - 20 units on average depending on muscle bulk

Crows Feet (lateral canthal lines): 10 units per eye on average

 

 

Rarely patients develop antibodies to botulinum toxin and need additional dosing. About 30% of injections need "touch-ups" or follow up in order to achieve the desired results. Do not forget, BOTOX injection are not without complications (thankfully all short term). Talk with you injector in detail to get an idea of what to expect and possible complications. 

 

 

I hope this sheds some light on how many units you are getting or are planning to get. Remember to seek out a qualified injector and be wary of "too good to be true" deals. You get what you pay for!

 

More to come on my favorite injectable med.

Next: Common complications

 

Dr. Alexander Blinski