Botox, what are the truths that most doctors hide from you?

Do you think you find it annoying when people coax you into signing up fancy aesthetic procedures without telling you the actual worst case scenario that may come with it?

So what are the serious side effects that you have been dying to know about botox?
Truthfully, no serious complications

Among the common potential side effects are as below
1. Localized pain, swelling at site of injection
2. numbness over the botox area
3. redness of skin
4. Localized infection (if cleanliness is not strictly compliant)
5. minimal bleeding and bruising around site of injection
6. headache happens temporarily in minority of patient, which ironically botox is used to treat migraine
7. Ptosis (Sinkage) of eyelid or eyebrow, which probably should be listed the first in the list of complications
8. blurring of vision, if the injection is too near the eyes
9. Flu like symptom
10. Mr Spock's eyebrow

Mr Spock's eyebrow

Among the complications listed, you might think what is the big deal except the number 7 and 8. Usually complications can only arisen under the hand of inexperienced/unlicensed performer. But nothing to be worried about as it is easily correctable and the effect is reversed after botox wearing out in 3-4 months or usage of eyedrops


photo shown above is the example of eyelid ptosis, usually happens if the botox is injected slightly lower into the eye muscle region (due to spread of botox or anatomical difference among patients). It can be easily corrected by apraclonidine eyedrops 3 times a day to reverse the tiredness look. Otherwise, the ptosis will resolve itself after 2-3 weeks of persistent usage of eye muscles.

The concern also focus on the potential for Botox to migrate away from the original injection site, sometimes with disastrous consequences. 16 deaths have been attributed to botulinum toxin, although it has been reported that 15 of the 16 deaths were the result of injecting botox at a strength much stronger than that used for cosmetic purposes. So far only 1 death has been linked to Botox cosmetic: a 47-year old woman who died from complications associated with staphyloccus pneumonia seven weeks after a Botox Cosmetic injection.(which i think completely 2 unrelated issues)

The truth is, patients are getting younger too, and not waiting for the age lines to arrive. Brides are getting Botox injections in anticipation of their wedding day. It is no longer enough to look youthful, now, is the need to look perfect.

Botox, what you should know

Botox has inevitably become part of our lives. It is the symbol of everlasting youth and perfection. Little do us know about the story of the creation of this wonder drug... 

Let's go back to history, in 1980, Botox was initially used by Dr Alan for the first time in humans to treat strabismus. 

Subsequently in Dec 1989, BoNT-A (BOTOX®) was approved by the US Food and Drug Administration (FDA) for the treatment of strabismus, blepharospasm, and hemifacial spasm in patients aged younger than 12 years. 

In Apr 15, 2002, the FDA has finally announced the approval of BOTOX® Cosmetic to temporarily improve the appearance of moderate-to-severe frown lines between the eyebrows (glabellar lines). 

The principle reason for Botox injections to the face is that a small amount of Botox will partially and temporarily weaken the muscles and prevent or lessen the lines of the face. Improvement takes 5-14 days to be complete, and it may take several injections until we figure out the exact dose of Botox that works best for you.  If it turns out that the initial dose for the Botox is not sufficient to paralyze your muscles, usually next review will be scheduled in 1 month time as optimal result will manifest in 1 month. 

The lines that can be improved from Botox include the glabella frown lines (“eleven” lines between your eyebrows), crow’s feet and forehead lines. 

 Besides, the corners of the mouth can be injected to minimize downturn of the corners of the mouth, (to reduce droopiness)

 The upper lip lines can also be softened, but only a small effect can be expected here because injecting too much can give an unnatural appearance. Usually by combining with filler will create wonders.

 The crow feet can also be treated with Botox, but too much Botox there has an increased risk of eyelid droop.  

It can be used for the “bunny lines” or wrinkles along the side of the bridge of the nose or even in the armpits for excessive sweating as well as chin wrinkling.

bunny lines

chin wrinkling

Asides from the aforementioned indications, botox is also widely applied to girls who want a more defined V-shaped facial appearance. Hence, by weakening the masseter (jaw muscle) will give a more defined V-shape.

The complications and side effects of Botox are minimal.  You may have some swelling or bruising, especially around the crow’s feet, and this could last for several days after the injections.  The risk of bruising from Botox is minimal as we will avoid veins on visualisation. 

If too much Botox is placed in the forehead, this can lower your brow and look unattractive, it will be trickier if you are above 45 years old as excessive skin may sag. So, a more conservative technique will be adopted when treating eyebrow region  There have been rare reports of Botox causing minor headaches, but Botox has also been used to treat some kinds of migraine and tension headaches.

There are medications and herbals that can increase bruising and bleeding which you should avoid for two weeks before receiving Botox.  These are:  Advil, Aleve, Alka Seltzer, Anacin, Anaprox, Aspirin, Ascriptin, BC Powder, Bufferin, Coricidin, Dristan, Ecotrin, Empirin, Excedrin, Fiorinal, Feldene, Ibuprofen, Indocin, Lortab, Midol, Motrin, Naprosyn, Nuprin, Pepto Bismol, Percodan, Sinutab, Sudafed, Vitamin E and Voltaren.  

Many herbals can cause bleeding — Echinacea, Ginko Biloba, Ginseng, Licorice Root, St. John’s Wort, garlic tablets — and others have not been studied well enough to know what impact they will have, so it is best to stop ALL herbals two weeks before receiving Botox.

There are several newer botulinum toxin in the market, namely "Xeomin", "Dysport", and "Neuronox", which are safely applied on patients with comparable result in relative to Botox
Dysport tends to diffuse more into nearby tissues which can be a good or bad thing, depending on where it is injected.  

Neuronox is first launched to the world in 2005, approved by Korea FDA for usage around the globe. It produces comparatively as good result as Botox.

Of course you understand that this is a temporary treatment and can last from 3-6 months. Over time, the injections may need to be either less frequent or with a smaller dose, as the muscle becomes weaker and smaller.  

little sharing on my celebrity dad's botox profile