What Are the Most Commonly Reported Complications With Cosmetic Botulinum Toxin Type A Treatments?

Complications of neurotoxins used in cosmetic surgery

“…A recent review of the FDA Adverse Event database from 2014 to 2019 found that pain (9.3%), swelling (6.4%), and ptosis of the eyelid or brow (6.1%) were the most commonly reported adverse effect complaints. 2 The value of 6.1% noted for eyelid ptosis is higher than Phase 3 trials; however, this value was a grouped value of eyelid or brow ptosis. Patient-reported and provider-reported adverse events may differ.…”

“…All botulinum toxin neuromodulators require an FDA Black Box Warning highlighting the risk of potential for distant spread resulting in swallowing difficulties and death. [1][2][3][4] Most adverse events with botulinum toxins occur when used as a medical treatment where hundreds of units are often required.…”

“…7,8 In the most recent retrospective review of FDA adverse events, bruising (1.2%) was a commonly reported adverse event. 2 Patients should be informed that no matter how skilled the injector, bruising may still occur due to variability of facial blood flow, in addition to wound healing variability between individuals. 3 Areas with thin skin and superficial vessels are prone to bruising.…”

“…Lip ptosisLip ptosis may occur when injecting the lower and midface areas.Compared to the upper face, error in injection technique of the mid and lower face has a less forgiving effect. In the most recent review of FDA adverse event complaints, no complaints of lip ptosis were reported 2. An analysis of a large study with botulinum toxin reported that out of twenty patients injected in the upper lip for treatment of nasolabial folds only two patients experienced lip ptosis 3,18.…”

Analysis of Side Effects from Cosmetic Procedures with Botulinum Toxin

“…In other words, even if the procedure is performed on a route or depth that is known to be safe, blood vessel damage may occur because the procedure does not allow for direct visualization of all underlying structures. Moreover, blood vessels and the shape and distribution of muscles can differ from individual to individual [9,10]. Therefore, even the best efforts based purely on anatomical knowledge of the upper face would be unable to ensure a 100% safe procedure.…”