Anti-Wrinkle Injections Side Effects

What happens when Botox goes wrong?

by Dr Tim Pearce MBChB BSc (hons) MRCGP

Botox in Aesthetic medicine is actually an unusually safe medication- it’s extremely rare for it to cause systemic reactions, illness, or to react with other medication.

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    When Botox goes wrong, it’s usually because it’s had its usual effect – but in the wrong place.

    Botox in the wrong place

    Botox getting into the wrong place is responsible for nearly all the main side effects when ‘Botox goes wrong’.   So what are the key areas where you DON’T want Botox?

    1. The eyelid muscle: The muscle you blink can be affected by Botox- the result if a small amount of botox makes its way into this muscle is a slightly closed eyelid, termed a ‘ptosis’ in medical jargon.  It lasts usually around 6 weeks and can be treated.  Published data suggests a 1% risk, but my experience so far is zero out of 12 000 procedures.
    1. The tear gland: This gland is actually under the bone within your eye socket, but occasionally Botox makes its way there and causes dryness to that eye for weeks or months.  It is treated with eye drops and recovers in time.  I have likewise never had a client complain of this symptom.
    1. The eye muscles: The lateral rectus muscle is an important muscle for pulling your eyes outward.  Botox that makes its way here can cause double vision for weeks.  It’s usually subtle, but very annoying and can make driving unsafe if severe. It recovers fully with time.
    1. The forehead muscle above the eye: In some people, but not all, too much Botox in the muscle above the eyebrow can cause a heavy look, and an annoying inability to raise the brow to put make-up on.  It wears of naturally and can be improved by adding more Botox to the muscles that pull the eyebrow down, if they haven’t been treated already.
    1. Asymmetry: Sometimes worse than too much in the wrong place, is not enough in one side.  This can leave movement that looks obviously ‘wrong’ because it’s asymmetrical.  This is usually easily fixed with a follow-up.

    SkinViva’s rate of side effects has always been far better than the published data.

    There are two key approaches that help this.

    1.  Know the safety margins: Botox only spreads around 1 cm at most from its injection site.  If injections are kept at least 1cm away from important structures, that helps minimise risk.
    1. Know the correct depth: too often poorly trained injectors are distracted by the wrinkle, and not guided by an understanding of the position of the muscle underneath.  Injections given too deep are thought to be responsible for many of the side effects in the eyes.

    Knowing detailed anatomy is key.

    Botox® Doctors, Manchester & North West

    SkinViva in Manchester has a team of doctors & dentists are highly trained in advanced botulinum toxin injection techniques, making SkinViva an excellent choice for any patient seeking facial rejuvenation treatment in the North West.

    Alongside their own flagship Manchester Clinic, SkinViva also offer over 80 locations in Cheshire, Derbyshire, Lancashire, Manchester, Stockport and Bury.

    For further information or to arrange a confidential consultation, please call 0161 865 1141, email


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