Botox: Side Effects and Complications

Part 4 of 6: What can go wrong with Botox |

Botox side effects and complications

Botox is one of the most effective cosmetic wrinkle treatments, but as with all medicine, there are side effects and complications to consider. We will explore these issues, as well as common Botox mistakes and how to fix them, in the writing below.

If you are just joining us, the goal of this whole section about Botox on is to provide honest and well-researched information about this facial treatment for you to determine whether or not Botox is right for you. Part 1 discussed the benefits of Botox, including a before and after picture of my mom's own Botox treatment. Part 2 discussed how much Botox costs and how long results last. And Part 3 reviewed Botox safety.

This section will go over common side effects and complications when Botox is used as a cosmetic treatment for reducing wrinkles.

Common Side Effects for Cosmetic Botox

There is virtually no downtime associated with cosmetic Botox injections, but like with all medications, there are side effects. Fortunately, Botox side effects are mild and temporary for the most part, although reactions do vary across individuals. (Note: More serious side effects are discussed further below under Botox complications.)

Here is a list of common Botox side effects. I also discuss what side effects my mom experienced during her Botox treatments, as well as what can be done to minimize or reduce any of these side effects.

  1. Redness and swelling - After Botox is injected in your skin, you may experience redness and swelling at the injection site. Sometimes there is a tiny pink dot where the needle was inserted, but this mark goes away after a few minutes. Any post-Botox redness and swelling is usually temporary, with skin returning back to normal after 15-20 minutes or at most a few hours. Ice packs are usually applied before and after Botox injections to prevent any redness and swelling, but if you do experience redness and swelling, they will go away on their own without you having to do anything. Redness and swelling is a pretty common Botox side effect for most people. For my mom's Botox injections, she has experienced redness 5 out of 5 times and swelling 4 out of 5 times. These side effects disappear in the time it takes her to get home from the doctor's office. Redness and swelling are usually nothing to worry about.

  2. Pain at the injection site - Botox can hurt. However, it depends on your skin and the skill of the injector. Some people experience pain during Botox injections while others don't feel a thing! To minimize pain, the injection site is usually iced before and after the injections. The size of the needle can also influence how much Botox hurts. If you do experience pain, it usually only lasts as long as it takes to inject the Botox into your skin. Pain also seems to be attributed to the skill of the injector. My mom has gotten some painful Botox injections by some doctors, but her current doctor does a great job and she feels no pain at all. She has experienced pain maybe 2 out of 5 times.

  3. Bruising - Contrary to popular belief, a Botox bruise is not a sign of a botched Botox job. Bruising after Botox, or postinjection ecchymosis, can occur even with the most skilled Botox injector! There are two types of Botox bruises: immediate bruising and delayed bruising. Immediate bruising shows up a few hours after the injection, while delayed bruising can take 1-2 days (sometimes 3) before you see it on your skin.

    Why does Botox make your skin bruise? Well, if there is to be any bruising, it happens at the time Botox is injected into your skin. As the needle is inserted into your facial muscles, it may puncture a blood vessel, causing minor bleeding inside your skin. A physician will put slight pressure on the injected site for a few seconds to stop any bleeding and prevent bruising, but if the bleeding isn't completely stopped, you will get a bruise. Some people get bruises a few days after getting Botox because it takes time for the blood inside your skin to migrate to the surface of your skin and show up as a bruise.

    Bruising is more common when Botox is used to treat wrinkles around the eyes. To minimize the chance of bruising, many physicians will stretch your skin out under bright lights (and maybe even under a magnifying glass) to identify any blood vessels at the injection site in order to avoid those areas when inserting the needle. However, because there's no way of telling where veins and capillaries reside inside your skin, any needle can cause a bruise.

    Bruises from Botox will usually go way on their own after 7-14 days. Whether or not you'll bruise or how badly you will bruise really just depends, with luck being one of the factors. Some people are also more prone than others to getting bruises, but there are things you can do before you get Botox to minimize the chance that you will bruise. And if you do get bruises, there are ways to make the bruise go away faster too. These methods (ex. vascular lasers, topical vitamin K, arnica, etc). are covered in more detail later.

    For my mom's Botox treatment, she experienced bruising maybe 1 out of 5 times. When her skin did bruise post-Botox, the bruise went away in 2-3 days. Bruising is not as common as you think, but it isn't a rare Botox side effect either.

  4. Bleeding - Like bruising, some people experience minor, visible bleeding at the injection site once Botox is injected into the skin. This is because of reasons similar to the ones for post-Botox bruising. As the needle is inserted into your skin, it may nick a small capillary or vein, causing blood to spill out of the injection site. This minor bleeding stops very quickly and is similar to the bleeding you get when you pop a pimple. Whether or not you will experience bleeding will also depend on the skill and experience of your injector, as well as whether or not you are simply more prone to bleeding. My mom has experienced bleeding 2 out of 5 times she got Botox. It's interesting to note that the times she had physical bleeding at the injection site, her skin did not bruise. The time her skin did bruise after Botox, there was no blood outside the skin.

What you do before you get Botox, how your skin reacts, the needle size, the skill of the injector, and some luck are all factors that influence whether or not you will get any of the above side effects. They are the "usual suspects" when it comes to Botox side effects, but the above is by no means a complete list of them. Make sure you speak with your physician or Botox injector for more thorough information about what to expect from Botox.

Botox Complications

Cosmetic Botox complications are rare, but the injectable can cause serious side effects for some people. These complications may be attributed to technical error on part of the Botox injector (i.e. the person who's giving you the Botox doesn't know what he/she is doing). Laziness of an eyelid or double vision, for instance, may occur because of improper Botox application. Other Botox complications involve weakened muscles, allergic reactions, or Botox spreading to areas outside the injection site.

Here is a list of some (but not all) of the more serious Botox side effects:

  • Problems swallowing
  • Problems breathing
  • Muscle weakness or loss of strength
  • Double or blurred vision
  • Drooping eyelids
  • Change or loss of voice
  • Trouble enunciating words
  • Loss of bladder control
  • Headache
  • Dizziness or feeling faint
  • Itchiness or rash

If you experience any of the above symptoms at any time, call your doctor or get medical attention immediately. Some of these complications go away after the Botox wears off, but you must at the very least contact your Botox provider for further evaluation. Adverse reactions to a drug injected into your skin are not to be taken lightly. Don't just assume that any negative reactions will go away after awhile. If you have any kind of concern about whether your side effects are normal or not, go to your doctor right away!

In general, most Botox side effects are mild and tolerable. There are some more serious complications that require medical attention though. Always ask your doctor about these risks before you get Botox. Keep in mind that side effects and complications tend to be natural reactions to the treatment. Some people have bad experiences with Botox because of Botox mistakes.

Please continue to the next section to learn about common Botox mistakes and how they can be fixed!

Last updated: November 15, 2012

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Part 5: Botox Mistakes and How to Fix Them