This article covers the downsides, risks and possible complications of a Botox (botulinum toxin) treatment.

Too little Botox is used, so the result is not optimal. This often happens the first time you are treated by a practitioner.
Too much Botox is used, which can reduce facial expression. This is uncommon and temporary.
A drooping eyelid can occur if the injection is placed incorrectly. Recovery usually takes a few weeks. (The risk is less than 1%.)
Skin may become thinner after many years of frequent Botox use. This is more likely in people over 50.
You may be very pleased with the results and want to repeat the treatment once it wears off. This is sometimes considered the biggest “risk”.
Qualified practitioners work in line with professional guidelines and use sterile techniques. To reduce the risk of complications, they will assess whether any contraindications apply. Individuals with contraindications should not be treated.
Contraindications for a botulinum toxin treatment include:
An existing infection at the intended injection site
Pregnancy or breastfeeding
An allergy to any of the ingredients in botulinum toxin
Neuromuscular disorders that cause muscle weakness
Being under 18 years of age
After treatment, both side effects and complications may occur. Possible side effects include pain, swelling or bruising at the Botox injection site.
Common areas treated with botulinum toxin include frown lines, forehead lines and crow’s feet. The aim is to temporarily relax the muscles that cause wrinkles. If the wrong muscle is treated, this may result in an unnaturally raised eyebrow or a drooping eyelid. A drooping eyelid can occur if the injection is placed too low or if the botulinum toxin spreads slightly. In most cases, these effects resolve on their own within a few weeks.
Another possible complication from a cosmetic botulinum toxin treatment is infection. Although rare, this is a potential risk with any medical procedure.
Some people choose Botox to help manage headaches, as it can relax muscle tension. However, a headache may occur on the day of treatment in some individuals.
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In general, when administered by a qualified and registered healthcare professional, Botox is considered very safe. In the UK, hundreds of thousands of anti-wrinkle treatments are carried out each year using botulinum toxin. Botulinum toxin was approved for medical use by the FDA in 1989, and since then, millions of treatments have been performed worldwide.
Botox and Vistabel are brand names for botulinum toxin produced by Allergan. Other commonly used brands include Azzalure/Dysport and Bocouture/Xeomin. Botulinum toxin has been used in medicine for over 40 years and is also used to treat muscle spasms, strabismus, and certain urological and neurological conditions. This article provides general information about possible complications following cosmetic treatments with botulinum toxin.
Many people ask whether Botox can reach the brain. There is no evidence to suggest this occurs, as botulinum toxin works locally at the injection site.
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A Botox treatment for the forehead can sometimes cause a slightly heavy or unusual sensation in the first few days. Some people report difficulty focusing or mild headaches after their first treatment. These effects usually settle on their own.
Another downside is when too little Botox is used. In that case, forehead lines may remain visible, which can lead to disappointment. That said, many people are satisfied with the results and choose to repeat the treatment once it has worn off. Similar downsides can occur when treating frown lines.
Cosmetic treatments with botulinum toxin are considered to have a strong safety profile. Between 1989 and 2003, only a small number of complications were reported to the FDA compared with the large number of treatments performed. Many of these cases were associated with technique rather than the product itself.
If someone is allergic to botulinum toxin (which is extremely rare at the low doses used in cosmetic treatments), possible symptoms may include:
Headache or flu-like symptoms
Dry eyes or excessive tearing
Blurred vision
Asthma-like symptoms
These reactions are more commonly associated with higher doses used in medical treatments. The doses used for cosmetic procedures are much lower. If any of these symptoms occur after treatment, you should contact your practitioner promptly.
The main risks of a Botox treatment include mild bruising or redness at the injection site. Allergic reactions are very rare.
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To make sure your treatment is carried out safely, it’s important to keep the following points in mind when choosing a practitioner:
Ensure you are treated with one of the three recognised brands: Azzalure/Dysport, Bocouture/Xeomin or Botox/Vistabel.
Choose a doctor or prescribing nurse with experience in botulinum toxin treatments at a reputable clinic.
Consider whether it’s important to you to be treated by a medically qualified aesthetics professional.
Cosmetic treatments with botulinum toxin have a very strong safety profile. And you’re certainly not alone — every year, hundreds of thousands of people in the UK have Botox wrinkle treatments. That may be one of the reasons so many people look refreshed and confident!
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Read more:
Concerns in cosmetic care
Tear trough filler complications
Lip filler complications
This article is for general information only. It does not replace medical advice, a personal consultation or informed consent from your doctor.
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Botox is not harmful in the long term. There are people who have been using Botox for more than 30 years. In people over 50, it is known that very frequent use over many years may lead to slightly thinner skin
Too little Botox is used → results aren’t optimal.
Too much Botox is used → facial expression is reduced. This is uncommon and temporary.
A drooping eyelid → caused by an injection in the wrong spot. Recovery usually takes only a few weeks.
Skin thinning → may occur after many years of frequent use, most often in people over 50.
You’re so happy with the results that you want another treatment as soon as it wears off → this is perhaps the biggest “risk.”
Botox is made from botulinum, a substance produced by the bacterium Clostridium botulinum. Botulinum is a neurotoxin, but after a careful production process it is prepared in very low doses. In higher doses, botulinum toxin is used in medicine, for example to treat muscle spasms. In much lower doses, it is used in cosmetic treatments to reduce wrinkles
No, there is no evidence to suggest that Botox can reach the brain
The most common issues are either using too low a dosage or an incorrect injection technique. If the dosage is too low, the results may not be as effective as expected. When the injection technique isn’t quite right, the treatment may not work as well, or in rare cases, it can cause a slightly drooping eyelid. This usually resolves on its own within a few weeks and is uncommon
The injection itself can sting slightly, but this usually lasts no more than 10 seconds. The level of discomfort can vary depending on the practitioner.
A very small amount of bleeding at the injection site, usually no bigger than a pinprick. This normally disappears within about 6 hours.
Mild redness and/or swelling of the skin, which tends to fade within 24 hours.
A small bruise at the injection site, which usually clears within a few days. Any bruising can be covered with makeup.
After a first treatment in the forehead area, some people notice a slightly “heavy” or blurry feeling for the first 48 hours, which may cause a mild headache.
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