Key takeaways:
Botox (onabotulinumtoxinA) is an injectable medication used to smooth out wrinkles. It’s typically administered by a trained professional at a med spa or clinic.
Common Botox side effects include pain or irritation at the injection site, droopy eyelids, and headaches. Most Botox side effects are mild and temporary.
Rare but serious side effects, such as eye and vision problems or difficulty breathing, are also possible. When they happen, they’re often linked to the medication spreading to other parts of the body.
Save on related medications
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.
Common or mild side effects of Botox may include:
Pain, swelling, or bruising near the injection site
Headaches
Droopy eyelids or eyebrows
Dry and flaky skin
Rare but potentially serious Botox side effects include:
Swallowing or breathing problems
Vision changes or eye damage
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 10 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.
Validity matters: If you’re interested in giving Botox a try, make sure you’re getting the real deal. Find out how to tell the difference between real and fake Botox.
Exploring your options: Botox isn’t right for everyone. But thankfully there are alternatives to tackling wrinkles. Here’s how other anti-wrinkle treatments compare.
Pain or prevention? Botox can also provide preventive relief for migraines. But do Botox injections for migraine hurt? Dive into one person’s experience giving this migraine medication a “shot.”
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 them. 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 headaches 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 one-fifth 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 affect your heart, but this is rare. 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
Muscle weakness is a potential long-term side effect of Botox. In rare cases, the injected toxin can spread beyond the intended area, affecting nearby nerves or muscles. This has the potential to interfere with daily activities and may warrant medical attention.
People who are already living with muscle-related health problems, such as myasthenia gravis, may be at higher risk for experiencing these symptoms. In these situations, you should discuss the risks and benefits of Botox with a healthcare professional before treatment.
10. Antibody development and treatment resistance
Over time, your immune system can develop antibodies against botulinum toxin after repeated Botox injections. These antibodies aren’t harmful, but they can make the medication less effective. This means the smoothing results you once saw may gradually become weaker or stop working altogether.
The risk of developing antibodies is generally low. The risk is higher if you need frequent or high doses of Botox. If you notice your Botox treatments aren’t lasting as long or aren’t working as well as they used to, talk with your care team about possible alternatives or adjustments to your treatment plan.
Frequently asked questions
Botox side effects tend to be temporary. But people who receive frequent Botox Cosmetic injections over a long period of time can potentially develop long-lasting facial changes. These include changes in a person's facial expressions or being unable to make certain facial movements. To prevent serious Botox risks, make sure to go to a healthcare professional and clinic that’s trained and licensed to give these injections.
Botox may not be appropriate for everyone. Women who are pregnant or breastfeeding, and those with neuromuscular conditions such as myasthenia gravis, may want to avoid getting Botox. What’s more, if you have a skin infection at your preferred injection site, it’s best to wait until it clears before receiving Botox.
Certain medications, such as muscle relaxers, can also interact with Botox. So it’s important to share your updated medication list with your healthcare professional.
Botox’s effects aren’t permanent. It gradually wears off as your body breaks down the medication. Wrinkles and fine lines smoothed out by Botox injections will likely slowly start to reappear, typically 3 to 6 months after treatment.
Botox usually doesn’t cause lifelong changes to your skin or muscles after a single use. But repeated or long-term use of Botox injections can cause muscle weakness. This can make the smoothing results of Botox appear to last longer over time.
Botox side effects usually go away on their own over time. Mild effects, such as pain, irritation, or bruising at the injection site, typically resolve within a few days. More moderate side effects, such as droopy eyelids or muscle weakness, can last for a few weeks to months.
Botox is designed to work locally at the injection site by paralyzing specific muscles. But there’s a small risk that Botox can spread from the injection site to other parts of your body.
Fortunately, this isn’t common. This generally only happens if too much Botox is injected at once, it’s injected improperly, or you have certain health conditions that increase the risk of medication spreading.
Botox side effects tend to be temporary. But people who receive frequent Botox Cosmetic injections over a long period of time can potentially develop long-lasting facial changes. These include changes in a person's facial expressions or being unable to make certain facial movements. To prevent serious Botox risks, make sure to go to a healthcare professional and clinic that’s trained and licensed to give these injections.
Botox may not be appropriate for everyone. Women who are pregnant or breastfeeding, and those with neuromuscular conditions such as myasthenia gravis, may want to avoid getting Botox. What’s more, if you have a skin infection at your preferred injection site, it’s best to wait until it clears before receiving Botox.
Certain medications, such as muscle relaxers, can also interact with Botox. So it’s important to share your updated medication list with your healthcare professional.
Botox’s effects aren’t permanent. It gradually wears off as your body breaks down the medication. Wrinkles and fine lines smoothed out by Botox injections will likely slowly start to reappear, typically 3 to 6 months after treatment.
Botox usually doesn’t cause lifelong changes to your skin or muscles after a single use. But repeated or long-term use of Botox injections can cause muscle weakness. This can make the smoothing results of Botox appear to last longer over time.
Botox side effects usually go away on their own over time. Mild effects, such as pain, irritation, or bruising at the injection site, typically resolve within a few days. More moderate side effects, such as droopy eyelids or muscle weakness, can last for a few weeks to months.
Botox is designed to work locally at the injection site by paralyzing specific muscles. But there’s a small risk that Botox can spread from the injection site to other parts of your body.
Fortunately, this isn’t common. This generally only happens if too much Botox is injected at once, it’s injected improperly, or you have certain health conditions that increase the risk of medication spreading.
The bottom line
Botox Cosmetic (onabotulinumtoxinA) is an injectable medication used to improve the appearance of wrinkles. It’s injected into targeted areas of your face, such as your forehead or around your eyes. A medical version of Botox is also available.
Most people tolerate Botox well, but side effects are still possible. Pain and bruising at the injection site and headaches are some of the most common Botox side effects. Eye problems, such as droopy eyelids, dry eyes, and scratched corneas, are possible too. More serious side effects, such as difficulty breathing and swallowing, can also happen. To lessen the risk of serious problems, you should only get Botox Cosmetic at a licensed clinic and by a trained medical professional.
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References
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