Менеджмент осложнений после инъекций ботулотоксина типа А

Any cosmetic procedure is associated with a risk of complications and side effects, and botulinum toxin therapy – no exception.

Fortunately, the adverse events that occur after the administration of botulinum toxin resolve with the discontinuation of the drug – in 3–6 months.

However, in some cases, patients require urgent correction of the result.

In such cases, doctors will benefit from information on the main complications of correction with botulinum toxin type A and protocols for their successful management, provided in the article estet-portal .com by Dr. Ahsan Ullah (Ahsan Ullah).

Subjective complications after botulinum toxin administration

  • Unsatisfactory aesthetic result

Description: This complication of botulinum toxin correction depends on the perception of the result by the patient.

Unsatisfactory can be either undercorrection or overcorrection.

Prevention: At the consultation stage, it is important to carefully listen to the expectations of the patient and explain the possible results of botulinum therapy.

Photos before and after, as well as the use of a special scale to determine the severity of static and dynamic wrinkles (for example, Glogau), allow you to objectively evaluate the effect.

Management: 2 weeks after the initial botulinum treatment, a correction procedure can be performed, during which:

  • to enhance the effect, an additional dose of toxin is injected into the target area;
  • in case of overcorrection, botulinum toxin is injected into the contralateral muscles.

How to avoid complications after botulinum toxin injections

If there is a Spock effect (eyebrow lifted too high) after correction, a small amount of BoNT-A is injected into the levator brow muscle.

  • Asymmetry

Description: most often, asymmetry after botulinum toxin therapy appears in the eyebrow area as a result of an incorrect dosage of the drug or the strength of the patient's muscles.

Management: During a corrective procedure, the asymmetry can be corrected either by lowering the muscle with a botulinum toxin injection or by injecting the drug into the contralateral muscles.

For example, an excessively high brow lift can be corrected by injecting a toxin into the frontalis muscle that raises thebrow.

Short-term side effects and complications after botulinum toxin injections

Side effects that occur after botulinum toxin injections include:

    ecchymosis;
  • swelling;
  • temporary pain;
  • hypesthesia;
  • headaches.

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Description: Ecchymosis or bruising often results from damage to a blood vessel at the injection site, most commonly in the periorbital area.

Some patients report temporary pain or discomfort associated with skin piercing.

Headaches and hypoesthesia after botulinum toxin therapy may persist for 24-48 hours.

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Prevention: Reduce the severity and in some cases prevent bruising by tamponade during bleeding (a few seconds to a minute). Topical anesthetic creams

minimize discomfort during the procedure, as does

slow injection of the 30-gauge needle with an upward bevel. Some of the side effects that occur after botulinum toxin injections include ecchymosis, swelling, temporary pain, hypoesthesia and headaches.

Management
: For headaches (a temporary side effect due to muscle spasm), you can take

analgesics, which are sold without a doctor's prescription.

Allergic reaction
  • Description
: Skin reactions and redness may occur at any injection site; rarely there is a sharp reddening of the face, swelling of the lips and difficulty breathing.

Prevention

: To minimize the risk of allergic reactions, the patient's history should be taken carefully.

Management

: erythema normally resolves within 24 hours; if redness persists longer,

antihistamines. In case of anaphylactic shock

call an ambulance and administer adrenaline.

Required Reading: Algorithm for Anaphylaxis Emergency Care

Ptosis and diplopia
  • Description
: Eyebrow and eyelid ptosis – the result of improper administration or migration of the toxin to the lateral part of the eyebrow.

The lateral part of the frontalis muscle weakens, the drug diffuses into the levator of the upper eyelid.

Ptosis of the upper or lower lip similarly occurs if the toxin is injected too close to the border of the red border of the lips.

Prevention

: Eyebrow ptosis often occurs when working with the forehead muscles in patients with pre-existing brow ptosis.

The risk of this complication can be minimized by avoiding the outer brow area when injecting the toxin into patients with a normal brow position.

For the lips, it is important not to inject botulinum toxin

near the vermilion border of the lips

.

It is better to administer the drug in small doses – 1–2 units each to prevent localized spread and dysfunction of the levator and depressor muscles.

If complications develop in the periocular region, the patient should be referred to an ophthalmologist.

Management
:

in case of ptosis it is best to wait toxin wears off. If the patient needs immediate relief from ptosis, they should refer to an ophthalmologist

.

The specialized specialist will prescribe adrenomimetic drops

, which cause contraction of adrenergic muscles and raise the lower edge of the eyelid by 1–2 mm.

However, such symptomatic treatment should be continued until complete resolution of the ptosis.

In case of diplopia

, the patient should also be referred to an ophthalmologist, as there is a possibility that the drug was injected into the intraocular muscle.

The ophthalmologist will work on the antagonist intraocular muscle to correct the diplopia.

How to solve the problem of ptosis of the upper eyelid after the introduction of botulinum toxin preparations

Migration of the toxin from the injection site
  • Description
: Depending on the distribution area, the toxin can lead to a number of complications.

In the area around the eyes

is:

ptosis;

    ectropion of eyelid;
  • strabismus;
  • lagophthalmos;
  • brow lift.
  • Incorrect injection of botulinum toxin into the levators around the lips can lead to drooping of the red border.

Prevention

: strict adherence to the drug instructions, knowledge of the anatomy of the area to be corrected and the introduction of small amounts of botulinum toxin – the main ways to prevent the above complications.

Management

: in case of complications in the periocular region,

refer the patient to an ophthalmologist.

Infection
  • Description
: An infection site can form at any injection site due to inadequate cleaning and disinfection of the target area.

Prevention

: To avoid contamination, it is important to cleanse the skin with an antiseptic solution, remove all traces of makeup and use aseptic technique.

After the procedure, the patient is advised not to touch the area or apply make-up for at least 6 hours after the injection.

Botox Injections® in different age periods: when and what we correct

Treatment of infections

:

Course of antibiotics and monitoring of the affected area to avoid abscess formation that can lead to scarring. According to magazine Aesthetics

.

 

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