Most Common Complications After Botox®

Bruising, redness, swelling, tenderness

Prevention

• Gentle technique, small needles, firm pressure immediately post‑injection
• Avoid unnecessary anticoagulants when medically appropriate
• Advise limiting alcohol/fish oil/NSAIDs beforehand if safe

Care

• Cold compresses first 24 hours; arnica per clinic preference
• Time is the main remedy

Headache or pressure sensation

• Common in first‑timers or after forehead/glabellar treatment

Care

• Rest, hydration, acetaminophen per local guidance
• Usually resolves within 24–72 hours

Flu‑like malaise

• Uncommon and short‑lived; supportive care

Brow ptosis (heavy/low brow)

Cause

• Excessive frontalis relaxation or unopposed brow depressors

Prevention

• Preserve enough frontalis function; tailor dose to brow position/skin laxity
• Avoid low points near the brow in heavy‑lidded patients

Management

• Time is primary
• Consider small doses to depressors (corrugator/procerus/lateral orbicularis) to rebalance if appropriate at review
• Adjust mapping next session

“Spock” brow (lateral brow over‑arch)

Cause

• Undertreating lateral frontalis relative to central forehead

Prevention

• Include conservative lateral frontalis points when indicated

Management

• Tiny corrective doses to lateral frontalis at day 10–14

Eyelid ptosis (true lid droop)

Cause

• Unintended diffusion to levator palpebrae superioris (often from low glabellar or central forehead placement)

Prevention

• Respect safe distances from the superior orbital rim
• Proper depth and medial‑to‑lateral angling
• Avoid massage post‑treatment

Management

• Reassure that most resolve in 2–8 weeks
• Consider alpha‑adrenergic eye drops (e.g., apraclonidine 0.5% or oxymetazoline 0.1%) to stimulate Müller’s muscle if appropriate
• Schedule close follow‑up

Dry eye or irritation

Cause

• Reduced blink strength or orbicularis over‑relaxation

Prevention

• Conservative lateral canthus dosing
• Caution in patients with pre‑existing dry eye or lagophthalmos

Management

• Preservative‑free lubricants, eyelid hygiene
• Refer to ophthalmology if persistent

Infection at injection sites (rare)

Prevention

• Skin antisepsis, single‑use needles, no needle re‑entry after touching non‑sterile surfaces

Management

• Assess for cellulitis (spreading warmth, tenderness, fever); treat per local guidelines and culture if indicated

Hypersensitivity or anaphylaxis (extremely rare)

Signs

• Urticaria, wheeze, hypotension

Management

• Follow emergency protocols (e.g., epinephrine for anaphylaxis), activate EMS; document and report

Patient selection and counseling

• Screen for pregnancy/breastfeeding, active infection at treatment sites, known hypersensitivity to components, and neuromuscular disorders (e.g., myasthenia gravis, Lambert‑Eaton)
• Review medications/supplements that increase bruising
• Align goals: Botox® softens dynamic lines; it does not lift tissue or erase etched static lines alone

Planning and technique

• Use conservative starting doses, especially for first‑timers
• Respect anatomical safety zones and depths; avoid low forehead placement in heavy lids; keep lateral canthus points safe from the globe
• Use appropriate dilution and small aliquots to minimize diffusion

Aftercare that matters

• For 4 hours: avoid rubbing, heavy hats/headbands, or lying flat
• For 24 hours: avoid strenuous exercise, saunas, and facials; keep the area clean and makeup light

Follow‑up structure

• Schedule a day 10–14 review at checkout
• Define a touch‑up policy (window, scope, potential fees) in writing