How to avoid complications after botulinum toxin injections

Botulinum toxin injections remain among the most popular aesthetic procedures due to their affordability, high safety profile and good results. However, no one, even the most experienced specialist, is immune from complications, therefore every practitioner should know how to minimize the likelihood of their occurrence and what measures to take in case of problems.

Dr. Daniel Chang discusses the risks associated with botulinum toxin injections and provides advice on how to prevent and manage complications and improve outcomes after such procedures.

Factors affecting the likelihood of complications after botulinum toxin

Complications after botulinum toxin injections are caused by several groups of factors associated with:

1. Patient (history and existing diseases):

• allergic reactions;
• Injection site infections;
• inflammatory diseases of the skin;
• neuromuscular diseases;
• pregnancy and lactation;
• taking antiplatelet agents and anticoagulants.

2. Doctor:

• drug dilution;
• Introduction technique.

3. Product:

• quality;
• storage.

Classification of potential complications after botulinum toxin administration

The author identifies 3 categories of complications that may occur after the introduction of botulinum toxin:

• general;
• serious;
• local.

1. General complications may occur regardless of the factors described above. These include:

• redness;
• swelling;
• bruises;
• pain;
• headache.

2. Serious complications:

• hypersensitivity reactions;
• urticarial rash;
• anaphylaxis.

3. Local complications:

• diffusion of the drug into non-target muscles;
• infections;
• undercorrection or overcorrection.

The following are ways to prevent or minimize these adverse reactions and complications, as well as the measures that the author recommends taking to eliminate them.

General complications after botulinum toxin, independent of the above factors

As for the category of general complications after the administration of botulinum toxin preparations, they can occur in each patient, as a rule, they resolve on their own and do not pose a danger.

Pain

Pain can be relieved with local anesthetics, ice compresses. To minimize pain during insertion, pinch the skin, inject slowly, and use a small gauge needle.

Bruises

Bruising can be reduced by using mountain arnica before the procedure, avoiding NSAIDs. The procedure itself must be carried out in good lighting conditions, using the correct insertion technique. Before injecting, you can stretch the patient's skin with your fingers to better see the blood vessels.

As for headaches after botulinum toxin injections, painkillers are used to relieve them.

Serious complications after botulinum toxin injections

Serious complications after the administration of botulinum toxin preparations are most often due to patient-related factors, namely existing diseases.

Hypersensitivity, allergic rash and anaphylaxis may be caused by the components of – mainly human albumin, lactose and sodium succinate.

Therefore, it is very important to collect a complete patient history: if cases of such allergic reactions have been observed before, the procedure is contraindicated for the patient.

In the event of serious complications, the main – Immediate medical action: identification of anaphylaxis and immediate action.

Read more: Anaphylactic shock develops: what should a cosmetologist do

Local complications after botulinum toxin correction

Local complications after botulinum toxin injection include:

• diffusion of the drug into the non-target muscle;
• infections;
• undercorrection or overcorrection.

Such problems are usually the fault of the doctor: incorrect technique of administration or dilution of the drug, but can also be due to the choice of the product.

To prevent the occurrence of complications after botulinum toxin, it is necessary to clearly know the anatomy of the corrected zone, the dosage of the drug used and the technique of its administration.

As far as dealing with complications, there is no quick fix in these cases. Patients should be advised that these effects are temporary.

In the upper part of the face, complications after injection of botulinum toxin are:

• surprised expression (Spock look);
• eyelid ptosis;
• eyebrow ptosis;
• diplopia;
• muscular asymmetry.

Eyebrow ptosis  may occur after the introduction of botulinum toxin in order to correct forehead wrinkles. Therefore, in this case, it is important to use the correct insertion technique: at least 3 cm above the eyebrow. Regarding the choice of patients, it is better not to perform the procedure on older patients and patients who have experienced such a complication in the past.

Ptosis of the eyelids – a complication that occurs after the correction of crow's feet and frown lines. To reduce the risk of this complication, try not to work with older patients and avoid injecting the drug within 1 cm of the orbital rim. For correction, 1 & ndash; 2 drops of Iopidine are prescribed 3 times a day – this method allows you to lift the eyelid by 1–2mm.

The so-called surprised expression (Spock look) may be the result of injection of the drug in the forehead area. To correct this complication after botulinum toxin, inject 2 units of the drug into the lateral part of the frontalis muscle, 2 cm above the eyebrow.

Diplopia, ectropion and asymmetric smile may be the result of crow's feet correction with botulinum toxin. To avoid such complications, the drug is injected 1 cm outside the orbital ridge, as well as above the upper edge of the zygomatic bone. In case of diplopia, the eyes can be covered with a bandage.

Complications in the middle third of the face include smile asymmetry, which can occur when botulinum toxin is injected into the masticatory muscle. The drug must be injected deeply to avoid getting into the smile muscle. Also, in order to avoid complications in the perioral region, when botulinum toxin is injected into the muscle that lowers the corners of the mouth, it is necessary to inject the drug laterally, pinching the muscle between the fingers.

For the lower face and neck, complications in this area include dysphagia. The doctor can reduce the risk of this complication by injecting a small dose of the drug superficially, holding the platysma between the fingers.

Procedures should always be performed under aseptic conditions to avoid the risk of infection. If such a complication still occurs after the administration of botulinum toxin, the patient is prescribed topical and oral antibiotics.

Undercorrection and overcorrection

Overcorrection with botulinum toxin injection can result from using too much of the drug, so it is better to start with a small amount and inject it slowly.

In case of overcorrection, the problem cannot be solved quickly. In this case, it is necessary to explain to the patient that such an undesirable phenomenon is temporary.

In case of insufficient correction, the patient is injected with the next dose of toxin.

The lack of effect after the introduction of botulinum toxin may be due to the patient's immunoresistance to the toxin or an attempt to correct static wrinkles. Improper injection technique and the use of denatured toxin can also cause this problem.

Complications after the introduction of botulinum toxins are quite rare. The task of the doctor – take measures aimed at minimizing the risks associated with injections of drugs: perform procedures under aseptic conditions, use the correct injection technique, choose only high-quality drugs, collect a complete patient history and refuse to perform the procedure if there are any contraindications.

According to Prime magazine.