**4. Complications**

Neurotoxins treatments are proven to be remarkably safe. All the reported adverse events are related to injection techniques, dosage, or volume of injection. Allergic reactions are very rarely encountered.

**37**

*Botulinum Toxin for the Face*

**Procedure specific**

**General**

*DOI: http://dx.doi.org/10.5772/intechopen.94495*

**How to avoid**

injection. **Ecchymosis** Avoid the superficial vasculature (proper lightening and

≤1 week. **Headache** Those at risk can receive prophylaxis acetaminophen. **Neutralizing antibodies** They block the pharmacologic activity of the treatment

Glabellar complex **Eyelid ptosis** due to toxin diffusion through the orbital

brow.

Frontalis • **Brow ptosis** due to overtreatment of the frontalis

Crow's feet • **Ectropion**, **diplopia**, or **lateral lower eyelid drooping**

Platysma **Dysphagia, hoarseness**, **weakness** of the flexors of the

units ≤50 U

Masseter hypertrophy • Salivary gland enlargement

lateral bony orbit

neutralizing antibodies.

the superior orbital rim.

points 1.5 cm above the brow.

small gauge (30–32) needles and ice packs.

stretch the skin for better visualization)

Patient counseling regarding the need to stop NSAIDs, aspirin or anticoagulant therapy prior to injection for

affecting 0.3–6% of patients, its incidence is much higher in patients receiving toxin treatments for medical indications. BTXN-B products are more immunogenic than BTXN-A. It is controversial whether there is cross reactivity across different serotypes of the toxin, however it is worth trying to shift the patient to another serotype e.g. from BTXN-A to BTXN-B as a solution for

septum, paralyzing the levator palpebrae superioris muscle, specially when injecting the mid pupillary line 1 cm above the bony supraorbital rim to obtain horizontal

Avoided by the lateral corrugator muscle subdermal injection and do not inject within a 1-cm distance above

muscle. Avoided by keeping the lower most injection

• Excessive lateral brow elevation **"Quizzical" brows** due to central fibers treatment, while the lateral fibers inadequately treated causing lateral brow elevation.

due to injection of the lateral rectus muscle so avoid deep intramuscular injection within 1 cm from the

• **Upper lip ptosis** due to injection into zygomaticus muscle. This can be avoided by not injecting during smiling and do not follow the lines inferiorly.

• **Smile limitation** and/or **asymmetry** which is avoided by injecting into the square-shaped safe area that is bounded by a line joining the oral commissure to the ipsilateral earlobe superiorly, the mandibular border inferiorly and the anterior and posterior borders of the muscle identified while patient grinds on his/her teeth.

neck, **dry mouth**. This is avoided by keeping the injection

It is treated with α-adrenergic eye drops, such as apraclonidine or phenylephrine eye drops.

**Pain** Topical anesthetics, lidocaine for vial reconstitution,

**Edema/ Erythema** Ice packs application immediately before and after

*Cosmetic Surgery*

**3.2 Pretreatment preparation**

**3.3 Post treatment instructions and care**

Contraindication [8, 17]:

albumin).

1.Infection at site of injection.

quinidine, and polymyxin.

**4. Complications**

diffusion to other non-injected muscles

dermatitis, atopic dermatitis and psoriasis.

7.Anti coagulant therapy or bleeding disorders.

Allergic reactions are very rarely encountered.

or lactation, it is categorized as C drug

2.Thorough skin cleansing using 70% alcohol before, during, and after injection

1.Ask the patient to frown and smile repeatedly for 30 minutes following injec-

2.Avoid massaging the treated areas within 3 hours after injection to minimize

3.For upper face, avoid bending over or strenuous physical activity (controver-

2.Known hypersensitivity reaction to any of the ingredients (toxin or human

3.Preexisting inflammatory skin condition at site of injection e.g. acne, contact

4.Pregnancy (reports of premature delivery no causal relationship was proven)

5.Neuromuscular disease or patients with preexisting difficulties in swallowing or breathing e.g. myathenia gravis, amyotrophic lateral sclerosis and myopathies. Those patients are more predisposed for marked muscle weakness, dysphagia or respiratory compromise the toxin unmasked subclinical disease in some patients, however BTXN injection was used successfully in others.

6.Co-administration with drugs interfering with neuromuscular activity as aminoglycosides, lincosamides, cholinesterase inhibitors, curare-like depolarizing blockers, succinylcholine, magnesium sulfate, calcium channel blockers,

Neurotoxins treatments are proven to be remarkably safe. All the reported adverse events are related to injection techniques, dosage, or volume of injection.

sial), lying down or sleeping for 3 hours following the injections.

3.Topical anesthesia can be used to minimize the pain.

4.Sterile injection technique using 1 ml 30 gauge needle.

tion to minimize the diffusion outside the injected muscles.

1.Removal of makeup

**36**


*Cosmetic Surgery*
