Managing Adverse Events Associated with Botulinum Toxin Type A

Abstract

Botulinum toxin A (BTXA) has become a widely used drug in cosmetic dermatology, not only to treat focal hyperhidrosis but also hyperkinetic facial lines, platysma bands, décolleté bands, and other skin features. The spectrum of possible adverse effects of BTXA is broad but fortunately those that have been observed with cosmetic use of this product are generally mild and transient. The major tools for preventing adverse effects from BTXA are knowledge and skill. Use of correct injection techniques is mandatory since most unwanted effects are caused by incorrect technique. Knowledge of the target structures, e.g. the facial and extrafacial muscles, allows physicians to select the optimal dose, time and technique. The most common adverse effects are pain and hematoma. In the periocular region, lid and brow ptosis are important adverse effects. Adverse effects such as pain, hematoma, ecchymosis, and bruising may also occur in the upper and lower face and at extrafacial sites. Other possible adverse effects seen in other indications that the user of BTXA in cosmetic dermatology should be wary of include induction headaches and possible interaction with concomitant medications. Induction of neutralizing antibodies due to cosmetic BTXA treatment has not been observed. This article also outlines recommendations regarding use of BTXA. Of these, the most important for avoiding most unwanted adverse effects are the proper techniques of dilution, storage, and injection, as well as the careful exclusion of patients with any contraindications. Pain, hematoma, ecchymosis, and bruising can be prevented by cooling the skin before and after BTXA injection. Upper lid ptosis may be partly corrected using apraclonidine or phenylephrine eyedrops. If simple rules relating to the indications for and application of BTXA are followed, this is a safe and effective drug in cosmetic dermatology.

Complications of Botulinum Toxin-A Injection in an Iranian Population

“…Blepharoptosis (upper eyelid droop) is uncommon (1% to 5%) (12,16). It is usually unilateral and marked at the end of the day with muscle fatigue.…”

Botulinum Neurotoxin: The Ugly Duckling

“…Numerous reliable, well-designed double-blind studies concerning the clinical application of botulinum toxins [75, 80, 93, 94] have confirmed beyond doubt that toxin administration under clinical supervision is fairly safe. The de facto confirmation of the safety of such interventions advocating wider, clinically supervised use of botulinum neurotoxins is reinforced by the existence of a strong theoretical background.…”

“…Although the pathology is manifested in the muscles, the causes of spasticity must be attributed to central nervous system damage. This damage disrupts the equilibrium between inhibitory and excitatory signals, resulting in increased muscle stimulation [80, 81]. The clinical features of muscle spasticity are mainly characterized by pain, permanent muscle shortening and lack of voluntary movements.…”

Facial rejuvenation for middle-aged women: a combined approach with minimally invasive procedures

“…6 The diffusion of the different drugs seems to be dependent on concentration. 7 BTX-A has an excellent safety profile 8 and has been used extensively for facial rejuvenation with a focus on hyperkinetic wrinkles and to improve facial wound healing after surgery.…”